Healthcare Provider Details

I. General information

NPI: 1487205266
Provider Name (Legal Business Name): JOURNEY ADULT DAY SOCIAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 S ELM EUGENE ST STE 1211
GREENSBORO NC
27406-2200
US

IV. Provider business mailing address

1451 S ELM EUGENE ST STE 1211
GREENSBORO NC
27406-2200
US

V. Phone/Fax

Practice location:
  • Phone: 336-596-6627
  • Fax:
Mailing address:
  • Phone: 336-596-6627
  • Fax:

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 Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: NANCY REDD HAIRSTON
Title or Position: OWNER/PARTNER
Credential:
Phone: 336-596-6627