Healthcare Provider Details

I. General information

NPI: 1346548856
Provider Name (Legal Business Name): JOY PERSONAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5895 BRANCH VALLEY WAY
CUMMING GA
30040-7090
US

IV. Provider business mailing address

5895 BRANCH VALLEY WAY
CUMMING GA
30040-7090
US

V. Phone/Fax

Practice location:
  • Phone: 770-906-3573
  • Fax: 678-947-4850
Mailing address:
  • Phone: 770-906-3573
  • Fax: 678-947-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number058-01-015-1
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number058-01-015-1
License Number StateGA

VIII. Authorized Official

Name: JOYCE AFRIYIE
Title or Position: CEO
Credential:
Phone: 770-906-3573