Provider Demographics
NPI:1013780907
Name:LONG JOURNEY TRANSITION HOMES
Entity type:Organization
Organization Name:LONG JOURNEY TRANSITION HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-425-5479
Mailing Address - Street 1:3104 E CAMELBACK RD # 2486
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:213-425-5479
Mailing Address - Fax:
Practice Address - Street 1:12820 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6902
Practice Address - Country:US
Practice Address - Phone:213-425-5479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AL PROPERTIES GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health