Provider Demographics
NPI:1962734855
Name:JOURNEYS CROSSING ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:JOURNEYS CROSSING ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN/ LICENSED ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEMASTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-298-0054
Mailing Address - Street 1:102 N STUART AVE
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827-1451
Mailing Address - Country:US
Mailing Address - Phone:540-298-0054
Mailing Address - Fax:540-298-7049
Practice Address - Street 1:102 N STUART AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1451
Practice Address - Country:US
Practice Address - Phone:540-298-0054
Practice Address - Fax:540-298-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility