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General NPI Number Information
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NPI Number | 1801343348
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Entity Type | Organization
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Legal Business Name | JOURNEY TO THE STARS, INC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 309 W 146TH ST
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City | DOLTON
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State | IL
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Zip | 60419-1410
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Country | US
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Telephone | 312-498-0276
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Fax |
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Provider Business Mailing Address
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Address Line | 309 W 146TH ST
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City | DOLTON
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State | IL
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Zip | 60419-1410
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Country | US
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Telephone | 312-498-0276
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. FELICIA LYNETTE NICHOLS
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Credential | MA
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Telephone | 773-386-1399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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