Healthcare Provider Details

I. General information

NPI: 1639937527
Provider Name (Legal Business Name): OUR JOURNEY HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 3RD ST STE 302
ALTON IL
62002-6179
US

IV. Provider business mailing address

200 W 3RD ST STE 302
ALTON IL
62002-6179
US

V. Phone/Fax

Practice location:
  • Phone: 618-509-5955
  • Fax: 636-800-2495
Mailing address:
  • Phone: 314-477-2469
  • Fax: 636-800-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMIKA NICHOL KEMPER
Title or Position: ADM
Credential: RN
Phone: 618-509-5955