Provider Demographics
NPI:1356891907
Name:JNB HEADWATERS, LLC
Entity type:Organization
Organization Name:JNB HEADWATERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:OWSIANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-202-1268
Mailing Address - Street 1:16791 S BRYNMAWR RD
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:CO
Mailing Address - Zip Code:80470-8855
Mailing Address - Country:US
Mailing Address - Phone:303-838-9784
Mailing Address - Fax:303-838-9784
Practice Address - Street 1:16791 S BRYNMAWR RD
Practice Address - Street 2:
Practice Address - City:PINE
Practice Address - State:CO
Practice Address - Zip Code:80470-8855
Practice Address - Country:US
Practice Address - Phone:303-838-9784
Practice Address - Fax:303-838-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty