Provider Demographics
NPI:1316775091
Name:JOURNEY2WELLNESS, LLC
Entity type:Organization
Organization Name:JOURNEY2WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:402-884-9059
Mailing Address - Street 1:909 N ADAMS ST UNIT 460700
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E GOLD COAST RD STE 340
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4131
Practice Address - Country:US
Practice Address - Phone:402-884-9059
Practice Address - Fax:833-875-0053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY2WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-24
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty