Healthcare Provider Details

I. General information

NPI: 1679225403
Provider Name (Legal Business Name): LJS COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E APACHE BLVD APT 3060
TEMPE AZ
85281-1185
US

IV. Provider business mailing address

1221 E APACHE BLVD APT 3060
TEMPE AZ
85281-1185
US

V. Phone/Fax

Practice location:
  • Phone: 775-354-3675
  • Fax:
Mailing address:
  • Phone: 775-354-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LONNIE J PHILLIPS-JACKSON
Title or Position: OWNER
Credential:
Phone: 775-354-3675