=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053916668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOURNEYS HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2020
-----------------------------------------------------
Last Update Date | 12/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 727 TRENTON ST
-----------------------------------------------------
City | HARRIMAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37748-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-316-4571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 727 TRENTON ST
-----------------------------------------------------
City | HARRIMAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37748-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-316-4571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. SHANEIKA RAYAUNA WILLIAMS
-----------------------------------------------------
Credential | CNA, ASSOCIATES HCA
-----------------------------------------------------
Telephone | 865-316-4571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------