MEDICARE: YOUR JOURNEY CARE CONNECTION LLC

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	164W00000X	Licensed Practical Nurse

General Provider Information

NPI Number	:	1093526303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR JOURNEY CARE CONNECTION LLC

Provider Business Mailing Address
First Line	:	2205 FERNDALE AVE
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-2739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 FERNDALE AVE
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-2739
Country	:	US
Telephone Number	:	908-887-8746
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	YAHSHEE GARNER
Credential	:
Telephone Number	:	804-704-7928

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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