Provider Demographics
NPI:1154662518
Name:JOYFUL LIVING AT HOME LLC
Entity Type:Organization
Organization Name:JOYFUL LIVING AT HOME LLC
Other - Org Name:GOLDEN LIVING AT HOME LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-349-5081
Mailing Address - Street 1:4427 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5601
Mailing Address - Country:US
Mailing Address - Phone:703-218-1841
Mailing Address - Fax:
Practice Address - Street 1:7513 PRESIDENTIAL LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2628
Practice Address - Country:US
Practice Address - Phone:703-349-5081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO13903251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO13903OtherVIRGINIA DEPARTMENT OF HEALTH