Provider Demographics
NPI:1548559230
Name:JOURNEY 4 LIFE LLC
Entity Type:Organization
Organization Name:JOURNEY 4 LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:FARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-723-3164
Mailing Address - Street 1:1119 BURTON ST SE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3367
Mailing Address - Country:US
Mailing Address - Phone:616-723-3164
Mailing Address - Fax:
Practice Address - Street 1:1119 BURTON ST SE
Practice Address - Street 2:SUITE 600
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3367
Practice Address - Country:US
Practice Address - Phone:616-723-3164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management