MEDICARE: JUNIPER HAVEN, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0555	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215935424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNIPER HAVEN, LP

Provider Business Mailing Address
First Line	:	205 S 10TH ST
Second Line	:	PO BOX 191
City	:	LAMAR
State	:	CO
Zip	:	81052-2622
Country	:	US
Telephone Number	:	719-336-3434
Fax Number	:	719-336-2708

Provider Business Practice Location Address
First Line	:	205 S 10TH ST
Second Line	:
City	:	LAMAR
State	:	CO
Zip	:	81052-2622
Country	:	US
Telephone Number	:	719-336-3434
Fax Number	:	719-336-2708

Authorized Official
Title or Position	:	DIRECTOR COMMUNITY ACCOUNTING
Name	:	MRS. LINDA C DONATO
Credential	:
Telephone Number	:	973-945-3526

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/26/2010

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