MEDICARE: JOURNEY COMMUNITY HEALTH & WELLNESS ORGANIZATION INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1023433471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY COMMUNITY HEALTH & WELLNESS ORGANIZATION INC

Provider Business Mailing Address
First Line	:	730 N EASTERN AVE STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-2885
Country	:	US
Telephone Number	:	702-994-3635
Fax Number	:	702-664-0648

Provider Business Practice Location Address
First Line	:	6822 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4590
Country	:	US
Telephone Number	:	702-830-2481
Fax Number	:	702-664-0648

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER J FLORES
Credential	:
Telephone Number	:	702-232-4390

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	09/02/2015

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