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General NPI Number Information
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NPI Number | 1861707283
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Entity Type | Organization
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Legal Business Name | STONEVIEW PCH, LLC
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 1092 PEGGY MCMILLAN DR
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City | LITHONIA
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State | GA
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Zip | 30058-6228
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Country | US
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Telephone | 770-879-6935
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Fax | 678-476-1699
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Provider Business Mailing Address
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Address Line | 1092 PEGGY MCMILLAN DR
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City | LITHONIA
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State | GA
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Zip | 30058-6228
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Country | US
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Telephone | 770-879-6935
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Fax | 678-476-1699
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. JANE MOYO
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Credential |
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Telephone | 404-819-0657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 044-01-903-9
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License Number State | GA
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