Provider Demographics
NPI:1871298745
Name:JOURNEY OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:JOURNEY OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAZMA
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:CSC-AD
Authorized Official - Phone:301-693-9027
Mailing Address - Street 1:2719 PULASKI HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-1315
Mailing Address - Country:US
Mailing Address - Phone:410-676-5433
Mailing Address - Fax:
Practice Address - Street 1:2719 PULASKI HWY STE 5
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1315
Practice Address - Country:US
Practice Address - Phone:410-676-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children