Provider Demographics
NPI:1285241422
Name:SPIRITUAL JOURNEY LLC
Entity type:Organization
Organization Name:SPIRITUAL JOURNEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONEE
Authorized Official - Middle Name:RESHAE
Authorized Official - Last Name:MCKEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-801-9331
Mailing Address - Street 1:511 STERLINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-3122
Mailing Address - Country:US
Mailing Address - Phone:318-309-1449
Mailing Address - Fax:
Practice Address - Street 1:511 STERLINGTON HWY
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-3122
Practice Address - Country:US
Practice Address - Phone:318-309-1449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility