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General NPI Number Information
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NPI Number | 1841709573
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Entity Type | Organization
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Legal Business Name | JOURNEYPURE ORLANDO LLC
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 09/26/2017
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Provider Practice Location Address
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Address Line | 6903 UNIVERSITY BLVD
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City | WINTER PARK
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State | FL
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Zip | 32792-6707
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Country | US
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Telephone | 772-201-7892
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Fax |
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Provider Business Mailing Address
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Address Line | 618 NE JENSEN BEACH BLVD
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City | JENSEN BEACH
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State | FL
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Zip | 34957-4750
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Country | US
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Telephone | 772-225-2200
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. GEORGE K WINN JR.
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Credential |
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Telephone | 772-201-7892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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