Provider Demographics
NPI:1962995019
Name:JOYOUS LIFE INC
Entity type:Organization
Organization Name:JOYOUS LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-922-2060
Mailing Address - Street 1:2365 BRONCO DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771
Mailing Address - Country:US
Mailing Address - Phone:407-593-8037
Mailing Address - Fax:407-556-3283
Practice Address - Street 1:2365 BRONCO DRIVE
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771
Practice Address - Country:US
Practice Address - Phone:407-593-8037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163WA2000X
FLAL13118310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty