Healthcare Provider Details

I. General information

NPI: 1467365809
Provider Name (Legal Business Name): SERENITY COLLECTIVE 360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 WATAUGA DR
ATLANTA GA
30349-1519
US

IV. Provider business mailing address

1445 WOODMONT LN NW # 2227
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 404-330-9300
  • Fax:
Mailing address:
  • Phone: 404-330-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EDWINA BRUMBAUGH
Title or Position: PRESIDENT/OFFICE MANAGER
Credential:
Phone: 407-252-3445