Provider Demographics
NPI:1447282926
Name:SERENITY HOSPICE SERVCIES OF BATON ROUGE LLC
Entity type:Organization
Organization Name:SERENITY HOSPICE SERVCIES OF BATON ROUGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-338-3682
Mailing Address - Street 1:6363 MAIN ST
Mailing Address - Street 2:SUITE # E
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4084
Mailing Address - Country:US
Mailing Address - Phone:225-658-0220
Mailing Address - Fax:225-658-0014
Practice Address - Street 1:6363 MAIN ST
Practice Address - Street 2:SUITE # E
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4084
Practice Address - Country:US
Practice Address - Phone:225-658-0220
Practice Address - Fax:225-658-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191629Medicare Oscar/Certification