=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982570958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IGO SAFE JOURNEY ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2025
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 CONARD DR
-----------------------------------------------------
City | XENIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45385-2614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-768-3491
-----------------------------------------------------
Fax | 937-768-3491
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 CONARD DR
-----------------------------------------------------
City | XENIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45385-2614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-768-3491
-----------------------------------------------------
Fax | 937-768-3491
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOANNA M EDWARDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-768-3491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------