Healthcare Provider Details

I. General information

NPI: 1316875305
Provider Name (Legal Business Name): TRISTIAN'S JOURNEY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 RIVERSIDE STATION BLVD # 5460
SECAUCUS NJ
07094-4400
US

IV. Provider business mailing address

5000 RIVERSIDE STATION BLVD # 5460
SECAUCUS NJ
07094-4400
US

V. Phone/Fax

Practice location:
  • Phone: 888-717-2932
  • Fax:
Mailing address:
  • Phone: 888-717-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TRACEY JACKSON
Title or Position: CEO
Credential: MS EDUCATION ADMINIS
Phone: 888-717-2932