Provider Demographics
NPI:1467051508
Name:LIFES JOURNEY LLC
Entity Type:Organization
Organization Name:LIFES JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP HOME MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-462-9952
Mailing Address - Street 1:7591 N 85TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3982
Mailing Address - Country:US
Mailing Address - Phone:609-462-9952
Mailing Address - Fax:
Practice Address - Street 1:7591 N 85TH DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-3982
Practice Address - Country:US
Practice Address - Phone:609-462-9952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherPROCESS OF ACQUIRING OTHER IDENTIFIER