Provider Demographics
NPI:1861707283
Name:STONEVIEW PCH, LLC
Entity type:Organization
Organization Name:STONEVIEW PCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-819-0657
Mailing Address - Street 1:1092 PEGGY MCMILLAN DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6228
Mailing Address - Country:US
Mailing Address - Phone:770-879-6935
Mailing Address - Fax:678-476-1699
Practice Address - Street 1:1092 PEGGY MCMILLAN DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6228
Practice Address - Country:US
Practice Address - Phone:770-879-6935
Practice Address - Fax:678-476-1699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONEVIEW PCH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-01-903-9311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home