Provider Demographics
NPI:1720398282
Name:JOYFUL LIVING GROUP HOME #3
Entity Type:Organization
Organization Name:JOYFUL LIVING GROUP HOME #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WILLADEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-527-9045
Mailing Address - Street 1:2809 ELDORADO RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-1916
Mailing Address - Country:US
Mailing Address - Phone:910-483-0142
Mailing Address - Fax:910-864-8007
Practice Address - Street 1:2809 ELDORADO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-1916
Practice Address - Country:US
Practice Address - Phone:910-864-8000
Practice Address - Fax:910-864-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026902320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities