Provider Demographics
NPI:1992076608
Name:SERENITY HOSPICE CARE, LLC
Entity type:Organization
Organization Name:SERENITY HOSPICE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:262-735-4297
Mailing Address - Street 1:W175N11117 STONEWOOD DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6508
Mailing Address - Country:US
Mailing Address - Phone:262-735-4297
Mailing Address - Fax:
Practice Address - Street 1:W175N11117 STONEWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6508
Practice Address - Country:US
Practice Address - Phone:262-735-4297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based