| Journey Community Church | |
|
21270 Lorain Rd Fairview Park OH 44126-2121 | |
| (330) 554-4009 | |
| Not Available |
| Full Name | Journey Community Church |
|---|---|
| Speciality | Clinic/Center |
| Location | 21270 Lorain Rd, Fairview Park, Ohio |
| Authorized Official Name and Position | Mason Yoder (CONSULTANT) |
| Authorized Official Contact | 3305544009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Journey Community Church 21270 Lorain Rd Fairview Park OH 44126-2121 Ph: () - | Journey Community Church 21270 Lorain Rd Fairview Park OH 44126-2121 Ph: (330) 554-4009 |
| NPI Number | 1619685815 |
|---|---|
| Provider Enumeration Date | 11/07/2022 |
| Last Update Date | 07/06/2023 |
| Certification Date | 07/06/2023 |
| Medicare PECOS PAC ID | 7416303326 |
|---|---|
| Medicare Enrollment ID | O20231030001581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619685815 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Sarah E Tkac |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083159560 PECOS PAC ID: 2769893429 Enrollment ID: I20201201002793 |
| Provider Name | Audra Maria Popik |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205265188 PECOS PAC ID: 7618419235 Enrollment ID: I20240610003761 |
| Provider Name | Sally Longstreth Fluck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801336698 PECOS PAC ID: 3678016557 Enrollment ID: I20240620000495 |
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