Provider Demographics
NPI:1841761574
Name:NEW JOURNEY LIVING, LLC
Entity Type:Organization
Organization Name:NEW JOURNEY LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLORES
Authorized Official - Suffix:
Authorized Official - Credentials:JD, PHD
Authorized Official - Phone:916-385-4849
Mailing Address - Street 1:621 STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6250
Mailing Address - Country:US
Mailing Address - Phone:916-385-4849
Mailing Address - Fax:
Practice Address - Street 1:2497 S ROANE ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8670
Practice Address - Country:US
Practice Address - Phone:865-389-6991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty