Provider Demographics
NPI:1871109181
Name:JOURNEY HEALTH CENTER
Entity type:Organization
Organization Name:JOURNEY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP, PMHNP
Authorized Official - Phone:410-209-7041
Mailing Address - Street 1:1511 WILD CRANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2018
Mailing Address - Country:US
Mailing Address - Phone:410-209-7041
Mailing Address - Fax:410-510-1354
Practice Address - Street 1:1808 WOODLAWN DR STE O
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-4023
Practice Address - Country:US
Practice Address - Phone:410-298-0734
Practice Address - Fax:410-510-1354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD874086100Medicaid