Healthcare Provider Details

I. General information

NPI: 1780782748
Provider Name (Legal Business Name): JOYNER HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 WEBB ST
DETROIT MI
48204-1364
US

IV. Provider business mailing address

7429 E ROBINWOOD ST
DETROIT MI
48234-3160
US

V. Phone/Fax

Practice location:
  • Phone: 313-931-4544
  • Fax: 313-891-8019
Mailing address:
  • Phone: 313-931-4544
  • Fax: 313-891-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: KIMBERLY DENISE NICHOLS
Title or Position: CEO/OWNER
Credential:
Phone: 313-931-4544