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General NPI Number Information
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NPI Number | 1063678761
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Entity Type | Organization
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Legal Business Name | JOYOUS YEARS
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 1310 E 75TH ST
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City | CHICAGO
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State | IL
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Zip | 60619-1420
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Country | US
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Telephone | 630-384-1254
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Fax | 630-384-1217
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Provider Business Mailing Address
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Address Line | 2100 MANCHESTER RD BUILDING A SUITE 615
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City | WHEATON
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State | IL
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Zip | 60187-4579
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Country | US
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Telephone | 630-384-1254
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Fax | 630-260-4120
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Authorized Official
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Title or Position | SENIOR PROJECT MANAGER
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Name | MISS KEISHA ROLLS
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Credential | CPC
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Telephone | 630-384-1254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 036100650
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License Number State | IL
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