Provider Demographics
NPI:1427087394
Name:HEALING JOURNEY PSC
Entity type:Organization
Organization Name:HEALING JOURNEY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAYES-PRINCE, MD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-4071
Mailing Address - Street 1:3025 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4071
Mailing Address - Country:US
Mailing Address - Phone:270-444-4071
Mailing Address - Fax:270-444-4038
Practice Address - Street 1:3025 CLAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4071
Practice Address - Country:US
Practice Address - Phone:270-444-4071
Practice Address - Fax:270-444-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942856Medicaid
KYDC9148Medicare PIN
KY65942856Medicaid