1841413879 NPI number — JOURNEY MENTAL HEALTH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841413879 NPI number — JOURNEY MENTAL HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOURNEY MENTAL HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841413879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 KESSEL CT
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53711-6227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-280-2695
Provider Business Mailing Address Fax Number:
608-280-2705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 KESSEL CT
Provider Second Line Business Practice Location Address:
SUITE 49
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711-6275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-280-2695
Provider Business Practice Location Address Fax Number:
608-280-2705
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERTRAND
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
608-280-2695

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42108400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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