Provider Demographics
NPI:1467924324
Name:JOURNEYS BEHAVIOR LEARNING CENTER LLC
Entity Type:Organization
Organization Name:JOURNEYS BEHAVIOR LEARNING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:843-609-5885
Mailing Address - Street 1:3226 BRUNSWICK SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-3741
Mailing Address - Country:US
Mailing Address - Phone:843-609-5885
Mailing Address - Fax:
Practice Address - Street 1:1316 W DRAGOON TRL
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4713
Practice Address - Country:US
Practice Address - Phone:574-314-0843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities