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General NPI Number Information
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NPI Number | 1891998217
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Entity Type | Organization
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Legal Business Name | LIFE'S JOURNEY
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 2904 S OUTER BELT RD
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City | OAK GROVE
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State | MO
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Zip | 64075-8152
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Country | US
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Telephone | 816-690-7305
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Fax | 816-625-3040
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Provider Business Mailing Address
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Address Line | 2904 S OUTER BELT RD
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City | OAK GROVE
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State | MO
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Zip | 64075-8152
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Country | US
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Telephone | 816-690-7305
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Fax | 816-625-3040
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ROXANNE HALL
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Credential |
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Telephone | 816-690-7305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 00690240
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License Number State | MO
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