MEDICARE: JOURNEY OF FAITH BEHAVIORAL HEALTH 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780008151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY OF FAITH BEHAVIORAL HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	308 PRINCESS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3809
Country	:	US
Telephone Number	:	310-612-3778
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 PRINCESS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3809
Country	:	US
Telephone Number	:	310-612-3778
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN JEFFERSON
Credential	:
Telephone Number	:	310-612-3778

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	02/06/2014

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