Provider Demographics
NPI:1962094664
Name:THE JOURNEY FOUNDATION, INC.
Entity type:Organization
Organization Name:THE JOURNEY FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-365-0346
Mailing Address - Street 1:910 S 8TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3771
Mailing Address - Country:US
Mailing Address - Phone:904-365-0346
Mailing Address - Fax:888-561-3842
Practice Address - Street 1:910 S 8TH ST STE 205
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3771
Practice Address - Country:US
Practice Address - Phone:904-365-0346
Practice Address - Fax:888-561-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2140OtherFACILITY CERTIFICATE NUMBER