Provider Demographics
NPI:1841709573
Name:JOURNEYPURE ORLANDO LLC
Entity type:Organization
Organization Name:JOURNEYPURE ORLANDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WINN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:772-201-7892
Mailing Address - Street 1:618 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4750
Mailing Address - Country:US
Mailing Address - Phone:772-225-2200
Mailing Address - Fax:
Practice Address - Street 1:6903 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6707
Practice Address - Country:US
Practice Address - Phone:772-201-7892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder