Healthcare Provider Details

I. General information

NPI: 1114467719
Provider Name (Legal Business Name): JOYFUL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5737 REGENT AVE N
CRYSTAL MN
55429-2814
US

IV. Provider business mailing address

5737 REGENT AVE N
CRYSTAL MN
55429-2814
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-4636
  • Fax:
Mailing address:
  • Phone: 612-481-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ADETOMI O OMOTAYO
Title or Position: OWNER
Credential:
Phone: 612-481-4636