Provider Demographics
NPI:1013141407
Name:SUCCESSFUL JOURNEYS, LLC
Entity type:Organization
Organization Name:SUCCESSFUL JOURNEYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYAPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-310-6325
Mailing Address - Street 1:12224 N 45TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2312
Mailing Address - Country:US
Mailing Address - Phone:623-293-8022
Mailing Address - Fax:602-693-0628
Practice Address - Street 1:4434 N 153RD LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-6302
Practice Address - Country:US
Practice Address - Phone:623-535-1239
Practice Address - Fax:623-535-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3254320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430383Medicaid