MEDICARE: JOY-LITTLE ENTERPRISE 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306459359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOY-LITTLE ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	15744 BAINEBRIDGE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8349
Country	:	US
Telephone Number	:	904-469-5933
Fax Number	:	904-574-8141

Provider Business Practice Location Address
First Line	:	9148 RIDGE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-1265
Country	:	US
Telephone Number	:	904-683-9949
Fax Number	:	904-574-8141

Authorized Official
Title or Position	:	OWNER
Name	:	LAKEISHA JOY LITTLE
Credential	:
Telephone Number	:	904-469-5933

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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Directions to “JOY-LITTLE ENTERPRISE LLC ” Practice Location

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