Healthcare Provider Details

I. General information

NPI: 1760064190
Provider Name (Legal Business Name): OUR JOURN3I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 09/02/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 CAMP ST
PROVIDENCE RI
02906-1833
US

IV. Provider business mailing address

60 CHATHAM ST
PROVIDENCE RI
02904-2510
US

V. Phone/Fax

Practice location:
  • Phone: 401-307-1882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. QUATIA OSORIO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-307-1882