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General NPI Number Information
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NPI Number | 1114846474
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Entity Type | Organization
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Legal Business Name | SERENITY DIVINE HOME CARE
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 4732 SGODA RD
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City | MACON
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State | GA
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Zip | 31217-8855
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Country | US
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Telephone | 470-827-9599
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Fax | 478-305-7018
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Provider Business Mailing Address
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Address Line | PO BOX 3552
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City | SUWANEE
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State | GA
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Zip | 30024-0084
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Country | US
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Telephone | 470-827-9599
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Fax | 478-305-7018
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Authorized Official
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Title or Position | OWNER
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Name | SHAKINNA ROUSE
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Credential |
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Telephone | 470-827-9599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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