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General NPI Number Information
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NPI Number | 1467051508
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Entity Type | Organization
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Legal Business Name | LIFES JOURNEY LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 7591 N 85TH DR
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City | GLENDALE
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State | AZ
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Zip | 85305-3982
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Country | US
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Telephone | 609-462-9952
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Fax |
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Provider Business Mailing Address
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Address Line | 7591 N 85TH DR
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City | GLENDALE
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State | AZ
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Zip | 85305-3982
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Country | US
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Telephone | 609-462-9952
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Fax |
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Authorized Official
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Title or Position | GROUP HOME MANAGER
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Name | MR. RICARDO RAMOS
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Credential |
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Telephone | 609-462-9952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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