Provider Demographics
NPI:1174867592
Name:JEREMIAH'S JOURNEY
Entity Type:Organization
Organization Name:JEREMIAH'S JOURNEY
Other - Org Name:C.I.M CHRIST IN MOTION/COLUMBIA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACO
Authorized Official - Middle Name:ANN MARIE
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:0
Authorized Official - Phone:573-864-9697
Mailing Address - Street 1:206 AUSTIN AVE
Mailing Address - Street 2:D
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4066
Mailing Address - Country:US
Mailing Address - Phone:573-864-9697
Mailing Address - Fax:
Practice Address - Street 1:206 AUSTIN AVE
Practice Address - Street 2:D
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4066
Practice Address - Country:US
Practice Address - Phone:573-864-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C.I.M CHRIST IN MOTION/COLUMBIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21333238Medicaid