Provider Demographics
NPI:1679225403
Name:LJS COMMUNITY SERVICES LLC
Entity type:Organization
Organization Name:LJS COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-354-3675
Mailing Address - Street 1:1221 E APACHE BLVD APT 3060
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1185
Mailing Address - Country:US
Mailing Address - Phone:775-354-3675
Mailing Address - Fax:
Practice Address - Street 1:1221 E APACHE BLVD APT 3060
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1185
Practice Address - Country:US
Practice Address - Phone:775-354-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherNONE