Organization
JOURNEY OF LIFE TRANSFORMATION
Active
Other names
JOLT Support Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY NEAL (OWNER/EXECUTIVE DIRECTOR)
(336) 995-1418
Entity
Organization
Contact information
Practice address
178 S PEACE HAVEN RD, WINSTON SALEM, NC 27104-4439
(336) 995-1418
(336) 448-5386
Mailing address
178 S PEACE HAVEN RD, WINSTON SALEM, NC 27104-4439
(336) 995-1418
(336) 448-5386
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
09/22/2023
Last updated
09/22/2023
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