Provider Demographics
NPI:1790875730
Name:JOYFUL LIVING DDA HOME, INC.
Entity Type:Organization
Organization Name:JOYFUL LIVING DDA HOME, INC.
Other - Org Name:JOYFUL LIVING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:704-481-9263
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-0013
Mailing Address - Country:US
Mailing Address - Phone:704-481-9263
Mailing Address - Fax:704-481-9263
Practice Address - Street 1:111 MORTON ST
Practice Address - Street 2:115 MORTON STREET
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6621
Practice Address - Country:US
Practice Address - Phone:704-481-9263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300515BMedicaid