Provider Demographics
NPI:1417955790
Name:JUNIPER PARK, LP
Entity Type:Organization
Organization Name:JUNIPER PARK, LP
Other - Org Name:JUNIPER VILLAGE-THE SPEARLY CENTER
Other - Org Type:Doing Business As
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:973-945-3626
Mailing Address - Street 1:2205 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3803
Mailing Address - Country:US
Mailing Address - Phone:303-458-1112
Mailing Address - Fax:303-433-1212
Practice Address - Street 1:2205 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3803
Practice Address - Country:US
Practice Address - Phone:303-458-1112
Practice Address - Fax:303-433-1212
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
CO0073314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05652565Medicaid
065327Medicare Oscar/Certification