Healthcare Provider Details

I. General information

NPI: 1427864735
Provider Name (Legal Business Name): BEJOY HOUSE OF JOY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19701 LULL ST
WINNETKA CA
91306-2676
US

IV. Provider business mailing address

19701 LULL ST
WINNETKA CA
91306-2676
US

V. Phone/Fax

Practice location:
  • Phone: 818-824-2253
  • Fax:
Mailing address:
  • Phone: 818-824-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BETTY GRAY
Title or Position: CEO / REGISTERED NURSE
Credential: RN
Phone: 818-824-2253