Provider Demographics
NPI:1013042290
Name:JOYFUL LIVING DDA HOME, INC.
Entity Type:Organization
Organization Name:JOYFUL LIVING DDA HOME, INC.
Other - Org Name:JOYFUL LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR OF SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:HAYNES
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN, QP
Authorized Official - Phone:704-481-9263
Mailing Address - Street 1:115 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6621
Mailing Address - Country:US
Mailing Address - Phone:704-481-9263
Mailing Address - Fax:704-482-1692
Practice Address - Street 1:115 MORTON ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6621
Practice Address - Country:US
Practice Address - Phone:704-481-9263
Practice Address - Fax:704-482-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-023-083320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409378Medicaid