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NPI Code Detail

MEDICARE: JOURNEY COMMUNITY CHURCH

MEDICARE: JOURNEY COMMUNITY CHURCH
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1619685815
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOURNEY COMMUNITY CHURCH
Provider Business Mailing Address
First Line : 21270 LORAIN RD
Second Line :
City : FAIRVIEW PARK
State : OH
Zip : 44126-2121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 21270 LORAIN RD
Second Line :
City : FAIRVIEW PARK
State : OH
Zip : 44126-2121
Country : US
Telephone Number : 330-554-4009
Fax Number :
Authorized Official
Title or Position : CONSULTANT
Name : MASON YODER
Credential :
Telephone Number : 330-554-4009
Provider Enumeration Date : 11/07/2022
Last Update Date : 07/06/2023

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Directions to “JOURNEY COMMUNITY CHURCH ” Practice Location

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