Provider Demographics
NPI:1760138101
Name:SUCCESSFUL JOURNEYS, LLC
Entity Type:Organization
Organization Name:SUCCESSFUL JOURNEYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEKOU
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MPA
Authorized Official - Phone:623-293-7792
Mailing Address - Street 1:20969 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-1645
Mailing Address - Country:US
Mailing Address - Phone:623-293-7792
Mailing Address - Fax:
Practice Address - Street 1:1518 W COMSTOCK DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1855
Practice Address - Country:US
Practice Address - Phone:623-293-8022
Practice Address - Fax:602-693-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1518Medicaid