Provider Demographics
NPI:1760949028
Name:JOURNEY HEALTH CENTER
Entity Type:Organization
Organization Name:JOURNEY HEALTH CENTER
Other - Org Name:JOURNEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-209-7041
Mailing Address - Street 1:1808 WOODLAWN DR STE H
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4023
Mailing Address - Country:US
Mailing Address - Phone:410-298-0734
Mailing Address - Fax:410-510-1354
Practice Address - Street 1:1808 WOODLAWN DR STE H&O
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4023
Practice Address - Country:US
Practice Address - Phone:410-298-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD874086101Medicaid