MEDICARE: JOURNEYS WITHIN, 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	311Z00000X	Custodial Care Facility	C209442-1114283	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568710879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEYS WITHIN, LLC

Provider Business Mailing Address
First Line	:	1422 20TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-6031
Country	:	US
Telephone Number	:	406-403-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 20TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-6031
Country	:	US
Telephone Number	:	406-403-0830
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. VIRGINIA T EADUS
Credential	:
Telephone Number	:	406-403-0830

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	08/16/2012

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