Provider Demographics
NPI:1407486830
Name:JOURNEY BIRTH SERVICES, LLC
Entity Type:Organization
Organization Name:JOURNEY BIRTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:307-622-1511
Mailing Address - Street 1:1012 COBURN AVE
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-3430
Mailing Address - Country:US
Mailing Address - Phone:307-622-1511
Mailing Address - Fax:307-939-7078
Practice Address - Street 1:1012 COBURN AVE APT 3
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3430
Practice Address - Country:US
Practice Address - Phone:307-622-1511
Practice Address - Fax:307-939-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing