MEDICARE: DYNAMIC JOY HOME HEALTH 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1750034369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC JOY HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	4433 WOODSON RD STE 104C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-3713
Country	:	US
Telephone Number	:	314-784-5960
Fax Number	:	314-784-5973

Provider Business Practice Location Address
First Line	:	4433 WOODSON RD STE 104C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-3713
Country	:	US
Telephone Number	:	314-784-5960
Fax Number	:	314-784-5973

Authorized Official
Title or Position	:	OWNER
Name	:	DEBRA JONES
Credential	:
Telephone Number	:	314-541-9485

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/03/2022

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