Healthcare Provider Details

I. General information

NPI: 1750738951
Provider Name (Legal Business Name): JUNIPER HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 NEW BRITAIN AVE
WEST HARTFORD CT
06110-2429
US

IV. Provider business mailing address

1086 NEW BRITAIN AVE
WEST HARTFORD CT
06110-2429
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-1418
  • Fax: 860-760-6305
Mailing address:
  • Phone: 860-523-1418
  • Fax: 860-760-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREI BREL
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 860-922-4466