Healthcare Provider Details

I. General information

NPI: 1396255261
Provider Name (Legal Business Name): GO JOURNEY JOURNAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11738 MACCORKLE AVE
CHARLESTON WV
25315-1035
US

IV. Provider business mailing address

11738 MACCORKLE AVE
CHARLESTON WV
25315-1035
US

V. Phone/Fax

Practice location:
  • Phone: 304-380-4892
  • Fax:
Mailing address:
  • Phone: 304-380-4892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA JEAN HILL
Title or Position: FOUNDER / CEO
Credential:
Phone: 304-380-4892