Provider Demographics
NPI:1780439000
Name:SOJOURN WELLNESS
Entity type:Organization
Organization Name:SOJOURN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-345-0859
Mailing Address - Street 1:1125 STRONG RD APT 101
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-8829
Mailing Address - Country:US
Mailing Address - Phone:850-345-0859
Mailing Address - Fax:
Practice Address - Street 1:1125 STRONG RD APT 101
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-8829
Practice Address - Country:US
Practice Address - Phone:850-345-0859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOJOURN WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility