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General NPI Number Information
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NPI Number | 1487315966
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Entity Type | Organization
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Legal Business Name | JOURNEY ABA NEVADA LLC
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 871 CORONADO CENTER DR STE 200
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City | HENDERSON
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State | NV
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Zip | 89052-3977
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Country | US
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Telephone | 817-966-2764
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Fax |
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Provider Business Mailing Address
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Address Line | 10019 REISTERSTOWN RD FL 3
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3902
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Country | US
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Telephone | 817-966-2764
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Fax |
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Authorized Official
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Title or Position | VP REVENUE STRATEGY
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Name | TERRI EDWARDS
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Credential |
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Telephone | 817-966-2764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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