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General NPI Number Information
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NPI Number | 1104140078
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Entity Type | Organization
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Legal Business Name | THE JOURNEY HOME, INC.
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 10875 FONTENOT RD
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-7302
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Country | US
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Telephone | 225-667-3933
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Fax | 225-667-9667
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Provider Business Mailing Address
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Address Line | 10875 FONTENOT RD
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-7302
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Country | US
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Telephone | 225-667-3933
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Fax | 225-667-9667
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRENDA BALLARD CAMP
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Credential | BSW
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Telephone | 225-667-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 242
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License Number State | LA
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