Basic Information
| Provider Information | |||||||||
| NPI: | 1104140078 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE JOURNEY HOME, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10875 FONTENOT RD | ||||||||
| Address2: | |||||||||
| City: | DENHAM SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707267302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256673933 | ||||||||
| FaxNumber: | 2256679667 | ||||||||
| Practice Location | |||||||||
| Address1: | 10875 FONTENOT RD | ||||||||
| Address2: | |||||||||
| City: | DENHAM SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707267302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256673933 | ||||||||
| FaxNumber: | 2256679667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2010 | ||||||||
| LastUpdateDate: | 03/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | CAMP | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | BALLARD | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2256673933 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 242 | LA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.