- Enrollment id
- O20170315000681
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1316374408
- Multiple npi flag
- N
- Ccn
- 741645
- Associate id
- 3375767973
- Organization name
- SERENITY HOSPICE ATX, LLC
- Doing business as name
- SERENITY HOSPICE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2604 HIGHWAY 71 E
- Address line 2
- BLDG B
- City
- BASTROP
- State
- TX
- Zip code
- 786025094