Provider Demographics
NPI:1518379155
Name:ST.JOHN, JOURNEY
Entity type:Individual
Prefix:MS
First Name:JOURNEY
Middle Name:
Last Name:ST.JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19414 W. RIDGEWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6738
Mailing Address - Country:US
Mailing Address - Phone:216-355-8185
Mailing Address - Fax:
Practice Address - Street 1:19414 W. RIDGEWOOD ROAD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6738
Practice Address - Country:US
Practice Address - Phone:216-355-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH400845681208376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069610Medicaid