Provider Demographics
NPI:1336756691
Name:FRIENDS OF JUNIPER FLATS CARE FACILITY
Entity Type:Organization
Organization Name:FRIENDS OF JUNIPER FLATS CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORETTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:951-821-1291
Mailing Address - Street 1:31311 SHADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8212
Mailing Address - Country:US
Mailing Address - Phone:195-182-1291
Mailing Address - Fax:800-853-4155
Practice Address - Street 1:31311 SHADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8212
Practice Address - Country:US
Practice Address - Phone:195-182-1291
Practice Address - Fax:800-853-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home