Provider Demographics
NPI:1356096945
Name:JJS ADULT DAY PROGRAM LLC
Entity Type:Organization
Organization Name:JJS ADULT DAY PROGRAM LLC
Other - Org Name:JJS DAY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PENNEBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-400-0994
Mailing Address - Street 1:986 NUCLA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-4343
Mailing Address - Country:US
Mailing Address - Phone:720-400-0994
Mailing Address - Fax:
Practice Address - Street 1:986 NUCLA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-4343
Practice Address - Country:US
Practice Address - Phone:720-400-0994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-13
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services