1164623237 NPI number — JOURNEY TOWARDS IMPROVED HEALTH

Table of content: (NPI 1164623237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164623237 NPI number — JOURNEY TOWARDS IMPROVED HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOURNEY TOWARDS IMPROVED HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOURNEY TOWARDS IMPROVED HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164623237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 CARVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOW HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28580-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-312-3818
Provider Business Mailing Address Fax Number:
336-450-4358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 N FRANKLIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27025-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-312-3818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
EVA
Authorized Official Middle Name:
Authorized Official Title or Position:
INDEPENT PRACTIONER/OWNER
Authorized Official Telephone Number:
336-312-3818

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: MHL041818 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-041-866 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8301990 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164623237 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301990H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301990G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6006886 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6604313 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301990B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164623237 . This is a "MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6604184 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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