NPIMap

Organization Active NPI

Serenity Hospice of Utah LLC

  • Community Based Hospice Care Agency
  • Pleasant Grove, UT
National Provider Identifier
1194426791
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SERENITY HOSPICE OF UTAH LLC
Practice address
627 W 4000 N
Pleasant Grove, UT 84062-8754
Phone
(801) 471-1965
NPI assigned
Mar 13, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Allison Evans
Title
Director of Nursing
Phone
(385) 452-2026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

627 W 4000 N
Pleasant Grove, UT 84062-8754

Mailing address

627 W 4000 N
Pleasant Grove, UT 84062-8754
Phone (801) 471-1965

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230524002969 UT Part A Provider - Hospice 8325404924 Practice locations: Pleasant Grove, UT

Hospice certification: CCN 461635

Legal name
SERENITY HOSPICE OF UTAH LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 27, 2023
Last certification
Aug 10, 2023
Organization structure
LLCProprietary
Incorporated
Mar 9, 2023 in UT
Enrollment address
627 W 4000 N
Pleasant Grove, UT 84062-8754

Care Compare: Hospice

Medicare Care Compare
Listed as
Serenity Hospice of Utah LLCCCN 461635
Certified
Aug 27, 2023
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2284993Serenity Hospice of Utah LLC627 W 4000 N, Pleasant Grove, UT 84062Certificate of waiverJul 2, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Deann Jones Individual 5% Or Greater Direct Ownership InterestConsultant Mar 9, 2023 10%
Matthew D Agresta Individual Contracted Managing EmployeeMD; Jun 26, 2023
Bret Trevor Jones Individual 5% Or Greater Direct Ownership InterestManager Mar 9, 2023 30%
W-2 Managing Employee Mar 9, 2023
Operational/Managerial ControlManager Mar 9, 2023
Allison Evans Individual 5% Or Greater Direct Ownership InterestClinical Management Director Mar 9, 2023 30%
Corporate DirectorClinical Management Director Mar 9, 2023
W-2 Managing Employee Mar 9, 2023
Austin Evans Individual 5% Or Greater Direct Ownership InterestNursing Director Mar 9, 2023 30%
Corporate DirectorNursing Director Mar 9, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1194426791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 W 4000 N",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840628754",
            "telephone_number": "801-471-1965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 W 4000 N",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840628754",
            "telephone_number": "801-471-1965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY HOSPICE OF UTAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "385-452-2026"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant Grove, UT

Sources for this page

Verify at the official NPI Registry.