Provider Demographics
NPI:1386115616
Name:LIFE'S JOURNEY LLC
Entity type:Organization
Organization Name:LIFE'S JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EROLD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:857-244-3382
Mailing Address - Street 1:354 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:354 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-4103
Practice Address - Country:US
Practice Address - Phone:857-244-3382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty