Provider Demographics
NPI:1417329053
Name:JOURNEYPURE WALNUT HOUSE LLC
Entity Type:Organization
Organization Name:JOURNEYPURE WALNUT HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-545-7266
Mailing Address - Street 1:116 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3522
Mailing Address - Country:US
Mailing Address - Phone:615-714-0483
Mailing Address - Fax:
Practice Address - Street 1:116 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3522
Practice Address - Country:US
Practice Address - Phone:615-714-0483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEYPURE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000017205261QM0801X, 261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder