Provider Demographics
NPI:1811163587
Name:JOYOUS YEARS ADULT DAY PROGRAM LTD
Entity type:Organization
Organization Name:JOYOUS YEARS ADULT DAY PROGRAM LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KING
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:773-493-0222
Mailing Address - Street 1:PO BOX 7163
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-7163
Mailing Address - Country:US
Mailing Address - Phone:773-493-0222
Mailing Address - Fax:773-493-0277
Practice Address - Street 1:1310 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1420
Practice Address - Country:US
Practice Address - Phone:773-493-0222
Practice Address - Fax:773-493-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100650261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4273517676015430OtherHFS PAYEE NUMBER
IL4273517676015430OtherHFS PAYEE NUMBER