Provider Demographics
NPI:1497347363
Name:FONDNESS OF JOY RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:FONDNESS OF JOY RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-482-4257
Mailing Address - Street 1:5451 BROADVIEW RD STE 3
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-7809
Mailing Address - Country:US
Mailing Address - Phone:216-482-4257
Mailing Address - Fax:
Practice Address - Street 1:9505 N CHURCH DR APT 206
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4793
Practice Address - Country:US
Practice Address - Phone:216-482-4257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1497347363Medicaid