Provider Demographics
NPI:1457089724
Name:OURWAY DEMENTIA
Entity Type:Organization
Organization Name:OURWAY DEMENTIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DEMENTIA SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANTELLE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-726-0405
Mailing Address - Street 1:1220 LAMBETH WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1753
Mailing Address - Country:US
Mailing Address - Phone:678-338-5812
Mailing Address - Fax:678-550-9941
Practice Address - Street 1:1220 LAMBETH WAY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1753
Practice Address - Country:US
Practice Address - Phone:470-726-0405
Practice Address - Fax:678-550-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care