Provider Demographics
NPI:1740280890
Name:JUNIPER VILLAGE AT STATE COLLEGE OPERATIONS II LLC
Entity type:Organization
Organization Name:JUNIPER VILLAGE AT STATE COLLEGE OPERATIONS II LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF MEMBER, JUNIPER PARTNERS LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-661-8300
Mailing Address - Street 1:400 BROADACRES DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3156
Mailing Address - Country:US
Mailing Address - Phone:973-661-8300
Mailing Address - Fax:
Practice Address - Street 1:1950 CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7662
Practice Address - Country:US
Practice Address - Phone:814-235-2074
Practice Address - Fax:814-235-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA281302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395756OtherCAPITAL BLUE CROSS
PA395756OtherGEISINGER
PA232431939OtherMEDICARE SUPPLEMENTS
PA395756OtherADVANTRA
PA1461OtherBLUE SHIELD
PA1461OtherBLUE SHIELD