Healthcare Provider Details

I. General information

NPI: 1861354383
Provider Name (Legal Business Name): LIFE'S A JOURNEY COMMUNITY SUPPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8217 GOULD AVE
LOS ANGELES CA
90046-1961
US

IV. Provider business mailing address

2934 1/2 N BEVERLY GLEN CIR UNIT 448
LOS ANGELES CA
90077-1745
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-8233
  • Fax:
Mailing address:
  • Phone: 310-770-8233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. CHELE MOORE
Title or Position: CEO
Credential:
Phone: 310-770-8233