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General NPI Number Information
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NPI Number | 1841655453
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Entity Type | Organization
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Legal Business Name | JOURNEYS HEALTHCARE
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Dates
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Enumeration Date | 12/24/2015
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Last Update Date | 12/24/2015
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Provider Practice Location Address
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Address Line | 515 CARVER MOORE RD
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City | LAKE WACCAMAW
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State | NC
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Zip | 28450-9713
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Country | US
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Telephone | 910-840-7481
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Fax |
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Provider Business Mailing Address
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Address Line | 515 CARVER MOORE RD
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City | LAKE WACCAMAW
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State | NC
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Zip | 28450-9713
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Country | US
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Telephone | 910-840-7481
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Fax |
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Authorized Official
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Title or Position | PRSEIDENT
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Name | MR. HAYNES ALMOND GRAHAM JR.
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Credential |
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Telephone | 910-840-7481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 146393
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License Number State | NC
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