Provider Demographics
NPI:1649982448
Name:JOURNEY HEALTH CLINICAL LLC
Entity type:Organization
Organization Name:JOURNEY HEALTH CLINICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-451-1288
Mailing Address - Street 1:1329 N 47TH ST UNIT 31112
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6787
Mailing Address - Country:US
Mailing Address - Phone:206-451-1288
Mailing Address - Fax:
Practice Address - Street 1:1525 11TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3903
Practice Address - Country:US
Practice Address - Phone:206-451-1288
Practice Address - Fax:833-783-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty