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General NPI Number Information
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NPI Number | 1861354383
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Entity Type | Organization
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Legal Business Name | JOURNEY OF LIFE COMMUNITY SUPPORT, LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 8217 GOULD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90046-1961
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Country | US
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Telephone | 310-770-8233
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Fax |
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Provider Business Mailing Address
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Address Line | 2934 1/2 N BEVERLY GLEN CIR UNIT 448
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City | LOS ANGELES
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State | CA
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Zip | 90077-1745
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Country | US
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Telephone | 310-770-8233
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CHELE MOORE
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Credential |
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Telephone | 310-770-8233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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