=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164090908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOY'S WELL CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2021
-----------------------------------------------------
Last Update Date | 06/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7340 PARKLANE RD STE 204-F
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29223-7644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-727-0231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 BRIGHTON HILL RD APT 5232
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29223-8625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-727-0231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | NIKKI GEORGIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-727-0231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------