1245655877 NPI number — A NEW JOURNEY HEALTHCARE & SENIOR SERVICES

Table of content: (NPI 1245655877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245655877 NPI number — A NEW JOURNEY HEALTHCARE & SENIOR SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A NEW JOURNEY HEALTHCARE & SENIOR SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245655877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7945 BURDELL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29209-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-569-6073
Provider Business Mailing Address Fax Number:
803-569-6072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7945 BURDELL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-305-1489
Provider Business Practice Location Address Fax Number:
803-883-5266
Provider Enumeration Date:
02/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
SHERREE
Authorized Official Middle Name:
ATONIETTE
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
803-445-4907

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  20144760046592 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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