MEDICARE: FOR THE JOY 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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366930067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOR THE JOY LLC.

Provider Business Mailing Address
First Line	:	3628 LA SCALA CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0828
Country	:	US
Telephone Number	:	702-326-3372
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 LA SCALA CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0828
Country	:	US
Telephone Number	:	702-326-3372
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RON RANDY RUTHERFORD
Credential	:
Telephone Number	:	702-326-3372

Provider Enumeration Date	:	04/27/2018
Last Update Date	:	04/27/2018

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