MEDICARE: LIFE'S JOURNEY SUPPORT SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1316885890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE'S JOURNEY SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	1003 NORFOLK SQ
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3234
Country	:	US
Telephone Number	:	757-622-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 NORFOLK SQ
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3234
Country	:	US
Telephone Number	:	757-622-0700
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BENICIA HERNANDEZ
Credential	:	LPC, LSATP
Telephone Number	:	757-714-6528

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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