A Broad Journey Intervention

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

Legal business name

A BROAD JOURNEY INTERVENTION

Practice address

619 W Beautiful LN
Phoenix, AZ 85041-8050

Phone

(602) 488-0135

Fax

(602) 314-6073

NPI assigned

Jun 10, 2016

Last updated

Jun 10, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Latanya King, MAED

Title

Ceo

Phone

(602) 488-0135

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465516800000",
    "number": "1942659990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6216 S 36TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850424904",
            "telephone_number": "602-488-0135",
            "fax_number": "602-314-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 W BEAUTIFUL LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850418050",
            "telephone_number": "602-488-0135",
            "fax_number": "602-314-6073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BROAD JOURNEY INTERVENTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-10",
        "last_updated": "2016-06-10",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "LATANYA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-488-0135",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MAED"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.