1992198071 NPI number — JOURNEY TOWARDS IMPROVED HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992198071 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:
Provider Other Organization Name Type Code:
6
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:
1992198071
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 STREET
Provider Second Line Business Practice Location Address:
OFFICE A
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27025-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-275-7973
Provider Business Practice Location Address Fax Number:
336-272-1325
Provider Enumeration Date:
03/12/2015

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCAS-20337 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: A10756 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0 . This is a "FEE FOR SERVICES UNTIL APPROVED FOR MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com