Provider Demographics
NPI:1972853976
Name:JOLLYLIFE INC
Entity Type:Organization
Organization Name:JOLLYLIFE INC
Other - Org Name:JOLLYLIFE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-558-3945
Mailing Address - Street 1:6962 ASPEN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2702
Mailing Address - Country:US
Mailing Address - Phone:214-558-3945
Mailing Address - Fax:
Practice Address - Street 1:6962 ASPEN CREEK LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-2702
Practice Address - Country:US
Practice Address - Phone:214-558-3945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care