Healthcare Provider Details

I. General information

NPI: 1114846474
Provider Name (Legal Business Name): SERENITY DIVINE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4732 SGODA RD
MACON GA
31217-8855
US

IV. Provider business mailing address

PO BOX 3552
SUWANEE GA
30024-0084
US

V. Phone/Fax

Practice location:
  • Phone: 470-827-9599
  • Fax: 478-305-7018
Mailing address:
  • Phone: 470-827-9599
  • Fax: 478-305-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAKINNA ROUSE
Title or Position: OWNER
Credential:
Phone: 470-827-9599