Healthcare Provider Details

I. General information

NPI: 1083234884
Provider Name (Legal Business Name): THE KATALUMA EXPERIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 FRIENDLY LN
LYNCHBURG SC
29080-8222
US

IV. Provider business mailing address

141 FRIENDLY LN
LYNCHBURG SC
29080-8222
US

V. Phone/Fax

Practice location:
  • Phone: 443-261-9793
  • Fax:
Mailing address:
  • Phone: 443-261-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. TOWANDA SERGENT
Title or Position: CEO
Credential: CNA, GNA,
Phone: 443-261-9793