Provider Demographics
NPI:1154157352
Name:STONE MOUNTAIN RUN OF JOURNEY LLC
Entity type:Organization
Organization Name:STONE MOUNTAIN RUN OF JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGUINNESS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:463-278-0868
Mailing Address - Street 1:5160 SPRINGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-1616
Mailing Address - Country:US
Mailing Address - Phone:770-498-4144
Mailing Address - Fax:770-498-4255
Practice Address - Street 1:5160 SPRINGVIEW AVE
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-1616
Practice Address - Country:US
Practice Address - Phone:770-498-4144
Practice Address - Fax:770-498-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility