Healthcare Provider Details

I. General information

NPI: 1225719800
Provider Name (Legal Business Name): JOYFUL ADVENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 PALMETTO AVE SE
HIGHLAND CITY FL
33846
US

IV. Provider business mailing address

PO BOX 1211
HIGHLAND CITY FL
33846-1211
US

V. Phone/Fax

Practice location:
  • Phone: 863-315-4562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WIEGMAN
Title or Position: OWNER
Credential: BCBA
Phone: 863-315-4562