Provider Demographics
NPI:1154835023
Name:SACRED JOURNEY FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:SACRED JOURNEY FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-244-9069
Mailing Address - Street 1:4840 QUARRYMAN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6625
Mailing Address - Country:US
Mailing Address - Phone:704-244-9069
Mailing Address - Fax:
Practice Address - Street 1:4840 QUARRYMAN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6625
Practice Address - Country:US
Practice Address - Phone:704-244-9069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)