Provider Demographics
NPI:1093911257
Name:JOURNEY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:JOURNEY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-280-2695
Mailing Address - Street 1:25 KESSEL CT
Mailing Address - Street 2:STE 105
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 MENDOTA ST
Practice Address - Street 2:STE 120
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1096
Practice Address - Country:US
Practice Address - Phone:608-280-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43422200Medicaid