MEDICARE: SERENITUDE BLOOM, 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	374J00000X	Doula

General Provider Information

NPI Number	:	1710874102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITUDE BLOOM, LLC

Provider Business Mailing Address
First Line	:	37118 SCENIC RIDGE DR
Second Line	:
City	:	GRAND ISLAND
State	:	FL
Zip	:	32735-8960
Country	:	US
Telephone Number	:	352-396-7822
Fax Number	:

Provider Business Practice Location Address
First Line	:	37118 SCENIC RIDGE DR
Second Line	:
City	:	GRAND ISLAND
State	:	FL
Zip	:	32735-8960
Country	:	US
Telephone Number	:	352-396-7822
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RUTH WALLACE-WILLIAMS
Credential	:
Telephone Number	:	352-396-7822

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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