Provider Demographics
NPI:1376661256
Name:JUNIPER VILLAGE AT CHATHAM, LLC
Entity Type:Organization
Organization Name:JUNIPER VILLAGE AT CHATHAM, LLC
Other - Org Name:JUNIPER VILLAGE AT CHATHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
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 1:500 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1407
Mailing Address - Country:US
Mailing Address - Phone:973-966-5483
Mailing Address - Fax:973-966-0119
Practice Address - Street 1:500 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1407
Practice Address - Country:US
Practice Address - Phone:973-966-5483
Practice Address - Fax:973-966-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ60A006310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004235Medicaid