MEDICARE: JOVIAL HOME HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1275483612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOVIAL HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	45 CHESAPEAKE DR
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-2694
Country	:	US
Telephone Number	:	678-670-4567
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 CHESAPEAKE DR
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-2694
Country	:	US
Telephone Number	:	678-670-4567
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NOLETHIA LAWRENCE
Credential	:
Telephone Number	:	678-670-4567

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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