Healthcare Provider Details

I. General information

NPI: 1962995019
Provider Name (Legal Business Name): JOYOUS LIFE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 BRONCO DRIVE
ST CLOUD FL
34771
US

IV. Provider business mailing address

2365 BRONCO DRIVE
ST CLOUD FL
34771
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-8037
  • Fax:
Mailing address:
  • Phone: 407-593-8037
  • Fax: 407-556-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL13118
License Number StateFL

VIII. Authorized Official

Name: FAYE BASTIAN
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 407-922-2060