MEDICARE: COMPANIONS ON THE JOURNEY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	MHL-041-796	NC

General Provider Information

NPI Number	:	1114093218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPANIONS ON THE JOURNEY, INC.

Provider Business Mailing Address
First Line	:	2640 WILLARD DAIRY RD
Second Line	:	SUITE 110
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8708
Country	:	US
Telephone Number	:	336-869-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 WILLARD DAIRY RD
Second Line	:	SUITE 110
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8708
Country	:	US
Telephone Number	:	336-869-1405
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LAURA JERENE STURGIS
Credential	:
Telephone Number	:	336-869-1405

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/02/2010

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