MEDICARE: JOYCO, INC.

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1649835034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYCO, INC.

Provider Business Mailing Address
First Line	:	PO BOX 9655
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65801-9655
Country	:	US
Telephone Number	:	417-773-1892
Fax Number	:	866-567-0791

Provider Business Practice Location Address
First Line	:	2030 W MOUNT VERNON ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-4846
Country	:	US
Telephone Number	:	417-864-8805
Fax Number	:	866-567-0791

Authorized Official
Title or Position	:	OWNER
Name	:	KATHY S MCCRARY
Credential	:
Telephone Number	:	417-773-1892

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	05/01/2019

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