Provider Demographics
NPI:1063678761
Name:JOYOUS YEARS
Entity Type:Organization
Organization Name:JOYOUS YEARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PROJECT MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:630-384-1254
Mailing Address - Street 1:2100 MANCHESTER RD
Mailing Address - Street 2:BUILDING A SUITE 615
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4579
Mailing Address - Country:US
Mailing Address - Phone:630-384-1254
Mailing Address - Fax:630-260-4120
Practice Address - Street 1:1310 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1420
Practice Address - Country:US
Practice Address - Phone:630-384-1254
Practice Address - Fax:630-384-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100650302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100650Medicaid
ILK53680Medicare PIN
IL036100650Medicaid