Provider Demographics
NPI:1801343348
Name:JOURNEY TO THE STARS, INC
Entity type:Organization
Organization Name:JOURNEY TO THE STARS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:773-386-1399
Mailing Address - Street 1:309 W 146TH ST
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1410
Mailing Address - Country:US
Mailing Address - Phone:312-498-0276
Mailing Address - Fax:
Practice Address - Street 1:309 W 146TH ST
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1410
Practice Address - Country:US
Practice Address - Phone:312-498-0276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management