Provider Demographics
NPI:1982262937
Name:SERENITY SHORE ASSISTED LIVING FACILITY, LLC
Entity Type:Organization
Organization Name:SERENITY SHORE ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOGARAJAH
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:SAVERUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:269-277-0970
Mailing Address - Street 1:3955 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9510
Mailing Address - Country:US
Mailing Address - Phone:269-471-5957
Mailing Address - Fax:
Practice Address - Street 1:1883 W GLENLORD RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9560
Practice Address - Country:US
Practice Address - Phone:269-408-8547
Practice Address - Fax:269-471-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility