Provider Demographics
NPI:1164689162
Name:JOY CARE
Entity Type:Organization
Organization Name:JOY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-781-7198
Mailing Address - Street 1:78 SKI HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368
Mailing Address - Country:US
Mailing Address - Phone:219-763-6821
Mailing Address - Fax:219-763-7792
Practice Address - Street 1:304 1/2 DETROIT STREET
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-781-7198
Practice Address - Fax:421-976-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100367640BMedicaid