Provider Demographics
NPI:1891814406
Name:JUNIPER VILLAGE AT WILLIAMSTOWN LLC
Entity Type:Organization
Organization Name:JUNIPER VILLAGE AT WILLIAMSTOWN LLC
Other - Org Name:JUNIPER VILLAGE AT WILLIAMSTOWN -WELLSPRING PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETATY
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 1:1648 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-9247
Mailing Address - Country:US
Mailing Address - Phone:856-740-4444
Mailing Address - Fax:856-740-4445
Practice Address - Street 1:1648 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-9247
Practice Address - Country:US
Practice Address - Phone:856-740-4444
Practice Address - Fax:856-740-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35A004310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8098654Medicaid