Provider Demographics
NPI:1043474463
Name:LIFE'S JOURNEY CENTER, INC.
Entity Type:Organization
Organization Name:LIFE'S JOURNEY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:TIJERINA
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-864-6363
Mailing Address - Street 1:291 E CAMINO MONTE VIS
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4710
Mailing Address - Country:US
Mailing Address - Phone:760-864-6363
Mailing Address - Fax:760-864-6360
Practice Address - Street 1:291 E CAMINO MONTE VIS
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4710
Practice Address - Country:US
Practice Address - Phone:760-864-6363
Practice Address - Fax:760-864-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330040AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330040APOtherSTATE OF CALIFORNIA LICENSE & CERTIFICATION