Healthcare Provider Details

I. General information

NPI: 1750896189
Provider Name (Legal Business Name): JOYFUL SENIOR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 PAYNE AVE STE 204
SAINT PAUL MN
55130-3667
US

IV. Provider business mailing address

1239 PAYNE AVE STE 204
SAINT PAUL MN
55130-3667
US

V. Phone/Fax

Practice location:
  • Phone: 215-971-4357
  • Fax: 651-209-8353
Mailing address:
  • Phone: 215-971-4357
  • Fax: 651-209-8353

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. DOUA XIONG
Title or Position: DIRECTOR
Credential:
Phone: 215-971-4357