Provider Demographics
NPI:1811434558
Name:SUCCESSFUL JOURNEYS INTEGRATED CARE
Entity type:Organization
Organization Name:SUCCESSFUL JOURNEYS INTEGRATED CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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:623-478-9400
Mailing Address - Street 1:8828 N CENTRAL AVE
Mailing Address - Street 2:206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2849
Mailing Address - Country:US
Mailing Address - Phone:623-478-9400
Mailing Address - Fax:623-478-9500
Practice Address - Street 1:8828 N CENTRAL AVE
Practice Address - Street 2:206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2849
Practice Address - Country:US
Practice Address - Phone:623-478-9400
Practice Address - Fax:623-478-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health