Healthcare Provider Details

I. General information

NPI: 1659069110
Provider Name (Legal Business Name): LEADING THE WAY GUIDED TRAVEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ROUTE 70 E STE K58
CHERRY HILL NJ
08003-2163
US

IV. Provider business mailing address

1930 ROUTE 70 E STE K58
CHERRY HILL NJ
08003-2163
US

V. Phone/Fax

Practice location:
  • Phone: 610-609-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA ANN ZIMMERMAN
Title or Position: OWNER
Credential:
Phone: 610-609-4600