Healthcare Provider Details

I. General information

NPI: 1497294714
Provider Name (Legal Business Name): JOYCE FAYE'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 MEENCH DR
MOORE OK
73170-7494
US

IV. Provider business mailing address

2126 MEENCH DR
MOORE OK
73170-7494
US

V. Phone/Fax

Practice location:
  • Phone: 405-565-5888
  • Fax:
Mailing address:
  • Phone: 405-565-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIA M TREVILLION
Title or Position: OWMER
Credential:
Phone: 405-565-5888