MEDICARE: SERENE STAYS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1427945419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENE STAYS LLC

Provider Business Mailing Address
First Line	:	2701 ARROWHEAD DR
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-3407
Country	:	US
Telephone Number	:	574-404-1524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 ARROWHEAD DR
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-3407
Country	:	US
Telephone Number	:	574-404-1524
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GERALD OLER
Credential	:
Telephone Number	:	574-404-1524

Provider Enumeration Date	:	06/21/2025
Last Update Date	:	08/02/2025

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