MEDICARE: LIFE'S A JOURNEY COMMUNITY SUPPORT, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	251X00000X	Supports Brokerage Agency
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1588523963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE'S A JOURNEY COMMUNITY SUPPORT, INC.

Provider Business Mailing Address
First Line	:	2934 1/2 N BEVERLY GLEN CIR # 448
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1745
Country	:	US
Telephone Number	:	310-770-8233
Fax Number	:

Provider Business Practice Location Address
First Line	:	8217 GOULD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1961
Country	:	US
Telephone Number	:	310-770-8233
Fax Number	:

Authorized Official
Title or Position	:	CEO & PRESIDENT
Name	:	MS. CHELE D MOORE
Credential	:
Telephone Number	:	310-770-8233

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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