Provider Demographics
NPI:1922495720
Name:SOJOURNERS RECOVERY & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:SOJOURNERS RECOVERY & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVE
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, LMHC, CAP
Authorized Official - Phone:407-739-3846
Mailing Address - Street 1:1349 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 2421
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1697
Mailing Address - Country:US
Mailing Address - Phone:407-739-3846
Mailing Address - Fax:321-249-0222
Practice Address - Street 1:1349 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2421
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1697
Practice Address - Country:US
Practice Address - Phone:407-739-3846
Practice Address - Fax:321-249-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1859AD288601251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health