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General NPI Number Information
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NPI Number | 1891257739
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Entity Type | Organization
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Legal Business Name | JOURNEY THERAPEUTIC OUTREACH SERVICES L.L.C.
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 110 N 4TH ST
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City | LEESBURG
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State | FL
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Zip | 34748-5167
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Country | US
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Telephone | 352-631-8568
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Fax |
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Provider Business Mailing Address
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Address Line | 110 N 4TH ST
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City | LEESBURG
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State | FL
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Zip | 34748-5167
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Country | US
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Telephone | 352-631-8568
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DUSTIN BASS
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Credential |
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Telephone | 352-631-8568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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