Provider Demographics
NPI:1477139582
Name:JOLLY HOME INC
Entity type:Organization
Organization Name:JOLLY HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-768-3132
Mailing Address - Street 1:9350 JAMAICA DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1706
Mailing Address - Country:US
Mailing Address - Phone:786-768-3132
Mailing Address - Fax:786-250-5180
Practice Address - Street 1:9350 JAMAICA DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1706
Practice Address - Country:US
Practice Address - Phone:786-768-3132
Practice Address - Fax:786-250-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness