Provider Demographics
NPI:1467875526
Name:JOURNEY HOMESTEAD, LLC
Entity Type:Organization
Organization Name:JOURNEY HOMESTEAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-375-4240
Mailing Address - Street 1:PO BOX 50178
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84605-0178
Mailing Address - Country:US
Mailing Address - Phone:801-375-4240
Mailing Address - Fax:801-375-4241
Practice Address - Street 1:920 COLUMBIA LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1320
Practice Address - Country:US
Practice Address - Phone:801-375-4240
Practice Address - Fax:801-375-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency