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General NPI Number Information
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NPI Number | 1871298745
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Entity Type | Organization
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Legal Business Name | JOURNEY OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 2719 PULASKI HWY STE 5
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City | EDGEWOOD
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State | MD
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Zip | 21040-1315
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Country | US
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Telephone | 410-676-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 2719 PULASKI HWY STE 5
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City | EDGEWOOD
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State | MD
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Zip | 21040-1315
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Country | US
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Telephone | 410-676-5433
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Fax |
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | MRS. JAZMA COATES
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Credential | CSC-AD
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Telephone | 301-693-9027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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