Healthcare Provider Details

I. General information

NPI: 1871298745
Provider Name (Legal Business Name): JOURNEY OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 PULASKI HWY STE 5
EDGEWOOD MD
21040-1315
US

IV. Provider business mailing address

2719 PULASKI HWY STE 5
EDGEWOOD MD
21040-1315
US

V. Phone/Fax

Practice location:
  • Phone: 410-676-5433
  • Fax:
Mailing address:
  • Phone: 410-676-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAZMA COATES
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: CSC-AD
Phone: 301-693-9027