Healthcare Provider Details

I. General information

NPI: 1093515256
Provider Name (Legal Business Name): JOY YOUTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 W 53RD ST
LOS ANGELES CA
90037-3436
US

IV. Provider business mailing address

14093 LEMOLI AVE
HAWTHORNE CA
90250-8860
US

V. Phone/Fax

Practice location:
  • Phone: 310-704-8705
  • Fax:
Mailing address:
  • Phone: 310-704-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GLORIA SHELL MITCHELL
Title or Position: FOUNDER, CEO
Credential: DMIN, PHD
Phone: 310-704-8705