Provider Demographics
NPI:1407583818
Name:SUCCESSFUL JOURNEYS, LLC
Entity Type:Organization
Organization Name:SUCCESSFUL JOURNEYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYAPONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-310-6325
Mailing Address - Street 1:12224 N 45TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2312
Mailing Address - Country:US
Mailing Address - Phone:615-310-6325
Mailing Address - Fax:
Practice Address - Street 1:22987 W YAVAPAI ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-8752
Practice Address - Country:US
Practice Address - Phone:623-293-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUCCESSFUL JOURNEYS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities