Provider Demographics
NPI:1720436330
Name:OUR JOURNEY TOGETHER, CORP.
Entity Type:Organization
Organization Name:OUR JOURNEY TOGETHER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:786-859-1068
Mailing Address - Street 1:7615 SW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4244
Mailing Address - Country:US
Mailing Address - Phone:786-859-1068
Mailing Address - Fax:
Practice Address - Street 1:12360 SW 132ND CT
Practice Address - Street 2:SUITE # 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6464
Practice Address - Country:US
Practice Address - Phone:786-859-1068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003720300Medicaid