Provider Demographics
NPI:1427427376
Name:JOURNEY'S COMMUNITY CENTER INC.
Entity type:Organization
Organization Name:JOURNEY'S COMMUNITY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-844-2124
Mailing Address - Street 1:4939 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2505
Mailing Address - Country:US
Mailing Address - Phone:304-844-2124
Mailing Address - Fax:
Practice Address - Street 1:4939 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2505
Practice Address - Country:US
Practice Address - Phone:708-683-9725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009820101YM0800X, 101YP2500X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty