MEDICARE: OURWAY DEMENTIA SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1023737079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OURWAY DEMENTIA SERVICES LLC

Provider Business Mailing Address
First Line	:	8455 HIGHWAY 85 BLDG 200
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-5115
Country	:	US
Telephone Number	:	678-651-7254
Fax Number	:	229-514-2204

Provider Business Practice Location Address
First Line	:	8455 HIGHWAY 85 BLDG 200
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-5115
Country	:	US
Telephone Number	:	678-651-7254
Fax Number	:	229-514-2204

Authorized Official
Title or Position	:	OWNER
Name	:	CHANTELLE JOHNSON JOHNSON
Credential	:	DEMENTIA SPECIALIST
Telephone Number	:	678-651-7254

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	02/05/2026

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Directions to “OURWAY DEMENTIA SERVICES LLC ” Practice Location

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