=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932013463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOYFUL HAVEN LIVING ASSISTED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3090 BOSTEDOR RD
-----------------------------------------------------
City | EATON RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48827-9028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-505-6218
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3090 BOSTEDOR RD
-----------------------------------------------------
City | EATON RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48827-9028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-505-6218
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PCA
-----------------------------------------------------
Name | TAMEKIA JOELINE HENRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-505-6218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------