1922495720 NPI number — SOJOURNERS RECOVERY & WELLNESS CENTER, LLC

Table of content: JUDSON WILLIAM BARBER MD (NPI 1811984032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922495720 NPI number — SOJOURNERS RECOVERY & WELLNESS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOJOURNERS RECOVERY & WELLNESS CENTER, LLC
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:
Provider Other Organization Name Type Code:
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:
1922495720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1349 S INTERNATIONAL PKWY
Provider Second Line Business Mailing Address:
SUITE 2421
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-1697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-739-3846
Provider Business Mailing Address Fax Number:
321-249-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1349 S INTERNATIONAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 2421
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-1697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-739-3846
Provider Business Practice Location Address Fax Number:
321-249-0222
Provider Enumeration Date:
04/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NAVE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
407-739-3846

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1859AD288601 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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