Provider Demographics
NPI:1104142959
Name:SERENITY HOLISTIC HOSPICE SERVICES OF ANACONDA, LLC
Entity type:Organization
Organization Name:SERENITY HOLISTIC HOSPICE SERVICES OF ANACONDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLOTKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-563-3017
Mailing Address - Street 1:903 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2001
Mailing Address - Country:US
Mailing Address - Phone:406-563-3017
Mailing Address - Fax:406-563-3017
Practice Address - Street 1:903 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2001
Practice Address - Country:US
Practice Address - Phone:406-563-3017
Practice Address - Fax:406-563-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-18
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based