=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023826765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3 J'S OF JOY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2024
-----------------------------------------------------
Last Update Date | 12/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3832 TWO OAKS RD
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-452-8009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3832 TWO OAKS RD
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-452-8009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JASON VANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-452-8009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------