Provider Demographics
NPI:1396369633
Name:JOURNEY THERAPY CONNECTION SERVICES, LLC
Entity Type:Organization
Organization Name:JOURNEY THERAPY CONNECTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:JARDA
Authorized Official - Last Name:NEPTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-294-6629
Mailing Address - Street 1:673 YORK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-4631
Mailing Address - Country:US
Mailing Address - Phone:770-294-6629
Mailing Address - Fax:
Practice Address - Street 1:673 YORK VIEW DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-4631
Practice Address - Country:US
Practice Address - Phone:770-294-6629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Multi-Specialty
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman FactorsGroup - Multi-Specialty