Provider Demographics
NPI:1073032298
Name:JOURNEY OF LIFE COMMUNITY SUPPORT, INC.
Entity type:Organization
Organization Name:JOURNEY OF LIFE COMMUNITY SUPPORT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-770-8233
Mailing Address - Street 1:2934 1/2 N BEVERLY GLEN CIR UNIT 448
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1745
Mailing Address - Country:US
Mailing Address - Phone:310-770-8233
Mailing Address - Fax:
Practice Address - Street 1:8217 GOULD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-1961
Practice Address - Country:US
Practice Address - Phone:310-770-8233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251X00000X, 172V00000X, 225700000X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty