- Enrollment id
- O20100331000294
- Enrollment state
- MS
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1730419722
- Multiple npi flag
- N
- Ccn
- 251660
- Associate id
- 6507992351
- Organization name
- SERENITY PREMIER HOSPICE, LLC
- Doing business as name
- ACG HOSPICE III
- Incorporation date
- 2009-09-02
- Incorporation state
- MS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3409 HALLS FERRY RD
- Address line 2
- STE 1
- City
- VICKSBURG
- State
- MS
- Zip code
- 391805525