Healthcare Provider Details

I. General information

NPI: 1841658994
Provider Name (Legal Business Name): JOYFUL JOURNEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LINDBERG RD
WEST LAFAYETTE IN
47906-2006
US

IV. Provider business mailing address

600 LINDBERG RD
WEST LAFAYETTE IN
47906-2006
US

V. Phone/Fax

Practice location:
  • Phone: 765-607-6156
  • Fax: 765-807-0293
Mailing address:
  • Phone: 765-607-6156
  • Fax: 765-807-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GERARD P BENNER
Title or Position: TREASURER / BOARD CHAIR
Credential:
Phone: 765-463-3890