MEDICARE: JOURNEYS OF HOPE YOUTH SERVICES, 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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235869348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEYS OF HOPE YOUTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	4416 ROSEMARY AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-5243
Country	:	US
Telephone Number	:	937-672-8092
Fax Number	:

Provider Business Practice Location Address
First Line	:	4416 ROSEMARY AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-5243
Country	:	US
Telephone Number	:	937-672-8092
Fax Number	:

Authorized Official
Title or Position	:	OWNER/HOUSE MANAGER
Name	:	DEVONNA A WOOD
Credential	:
Telephone Number	:	937-672-8092

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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