=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912446519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOY HEALTHCARE PROVIDERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2017
-----------------------------------------------------
Last Update Date | 02/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13652 BIRCHBARK CT
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462-1752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-476-1582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 E GOLF RD SUITE 950A
-----------------------------------------------------
City | SCHAUMBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60173-5834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-476-1581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DIANA HARMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-476-1581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 146.003021
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------