Provider Demographics
NPI:1750813218
Name:JOVIAL LIVING HOME LLC
Entity type:Organization
Organization Name:JOVIAL LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-855-7196
Mailing Address - Street 1:2144 HACIENDA CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8844
Mailing Address - Country:US
Mailing Address - Phone:469-520-5792
Mailing Address - Fax:
Practice Address - Street 1:2144 HACIENDA CT
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8844
Practice Address - Country:US
Practice Address - Phone:469-520-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home