Healthcare Provider Details

I. General information

NPI: 1073454716
Provider Name (Legal Business Name): CEDARWOOD SERENITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WINDOVER WAY
WARNER ROBINS GA
31088-6721
US

IV. Provider business mailing address

108 WINDOVER WAY
WARNER ROBINS GA
31088-6721
US

V. Phone/Fax

Practice location:
  • Phone: 646-418-8394
  • Fax:
Mailing address:
  • Phone: 646-418-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHANIECE RUMPH
Title or Position: PMHNP
Credential:
Phone: 646-418-8394