Provider Demographics
NPI:1508598707
Name:JUANITAS HAVEN
Entity Type:Organization
Organization Name:JUANITAS HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-451-3533
Mailing Address - Street 1:2413 BLUFF CREEK OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8101
Mailing Address - Country:US
Mailing Address - Phone:205-451-3533
Mailing Address - Fax:
Practice Address - Street 1:2413 BLUFF CREEK OVERLOOK
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8101
Practice Address - Country:US
Practice Address - Phone:205-451-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care