Provider Demographics
NPI:1215935424
Name:JUNIPER HAVEN, LP
Entity type:Organization
Organization Name:JUNIPER HAVEN, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR COMMUNITY ACCOUNTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-945-3526
Mailing Address - Street 1:205 S 10TH ST
Mailing Address - Street 2:PO BOX 191
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2622
Mailing Address - Country:US
Mailing Address - Phone:719-336-3434
Mailing Address - Fax:719-336-2708
Practice Address - Street 1:205 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2622
Practice Address - Country:US
Practice Address - Phone:719-336-3434
Practice Address - Fax:719-336-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0555314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05652052Medicaid
CO05652052Medicaid