Provider Demographics
NPI:1568996155
Name:JOURNEYPURE COLUMBIA LLC
Entity Type:Organization
Organization Name:JOURNEYPURE COLUMBIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-973-3500
Mailing Address - Street 1:502 N GARDEN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 N GARDEN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3238
Practice Address - Country:US
Practice Address - Phone:615-907-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEYPURE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-20
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility