MEDICARE: JOYOUS CARE & FAMILY PRESERVATION SERVICES, 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	163W00000X	Registered Nurse	R159343-5	MN

General Provider Information

NPI Number	:	1922418383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYOUS CARE & FAMILY PRESERVATION SERVICES, INC

Provider Business Mailing Address
First Line	:	8525 EDINBROOK XING
Second Line	:	SUITE 107C
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1900
Country	:	US
Telephone Number	:	763-315-5912
Fax Number	:	763-315-5916

Provider Business Practice Location Address
First Line	:	8525 EDINBROOK XING
Second Line	:	SUITE 107C
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1900
Country	:	US
Telephone Number	:	763-315-5912
Fax Number	:	763-315-5916

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	ELIZABETH OLUJOKE MAFE
Credential	:
Telephone Number	:	763-315-5912

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	11/15/2018

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