Provider Demographics
NPI:1639473838
Name:INDEPENDENT JOURNEYS LLC
Entity Type:Organization
Organization Name:INDEPENDENT JOURNEYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GROMALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-916-1276
Mailing Address - Street 1:30466 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-3308
Mailing Address - Country:US
Mailing Address - Phone:941-916-1276
Mailing Address - Fax:941-505-8153
Practice Address - Street 1:30466 CEDAR RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-3308
Practice Address - Country:US
Practice Address - Phone:941-916-1276
Practice Address - Fax:941-505-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management