Provider Demographics
NPI:1316676224
Name:JUNIPER ADULT HEALTH CENTER INC
Entity type:Organization
Organization Name:JUNIPER ADULT HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:BAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVADI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:301-717-9989
Mailing Address - Street 1:11108 BROAD GREEN DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2021
Mailing Address - Country:US
Mailing Address - Phone:301-717-9989
Mailing Address - Fax:
Practice Address - Street 1:11426 WILLOW GREEN CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-8528
Practice Address - Country:US
Practice Address - Phone:301-717-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017442720001Medicaid