Healthcare Provider Details

I. General information

NPI: 1487161519
Provider Name (Legal Business Name): THE JOURNEY OF KNOWLEDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 TERRY RD STE 400
JACKSON MS
39204-5777
US

IV. Provider business mailing address

2460 TERRY RD STE 400
JACKSON MS
39204-5777
US

V. Phone/Fax

Practice location:
  • Phone: 601-760-4803
  • Fax: 866-323-3772
Mailing address:
  • Phone: 601-760-4803
  • Fax: 866-323-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE Q MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-760-4803