Provider Demographics
NPI:1184483984
Name:PURE JOY SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:PURE JOY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENARA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WILLIAMS JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-524-2638
Mailing Address - Street 1:807 1ST AVE S APT 202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4385
Mailing Address - Country:US
Mailing Address - Phone:904-524-2638
Mailing Address - Fax:
Practice Address - Street 1:807 1ST AVE S APT 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4385
Practice Address - Country:US
Practice Address - Phone:213-371-7857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care