MEDICARE: JOYVIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	755105	OTHER	CO	INSURANCE

General Provider Information

NPI Number	:	1043817554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYVIDA LLC

Provider Business Mailing Address
First Line	:	755 HIGHWAY 105 STE D
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-8902
Country	:	US
Telephone Number	:	719-377-9121
Fax Number	:	719-355-8382

Provider Business Practice Location Address
First Line	:	755 HIGHWAY 105 STE D
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-8902
Country	:	US
Telephone Number	:	719-377-9121
Fax Number	:	719-355-8382

Authorized Official
Title or Position	:	OWNER CEO
Name	:	KEN A JENSON
Credential	:
Telephone Number	:	719-377-9121

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	07/31/2023

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Directions to “JOYVIDA LLC ” Practice Location

Language	Start Address	Practice Location

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