# JNB HEADWATERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356891907
- **Authorized official:** JAMES A OWSIANY (DIRECTOR)
- **Authorized official phone:** (720) 202-1268

## Contact information

- **Practice address:** 16791 S BRYNMAWR RD, PINE, CO 80470-8855
- **Practice address phone:** (303) 838-9784
- **Practice address fax:** (303) 838-9784
- **Mailing address:** 16791 S BRYNMAWR RD, PINE, CO 80470-8855
- **Mailing address phone:** (303) 838-9784
- **Mailing address fax:** (303) 838-9784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 376J00000X | Homemaker | — | NULL | — |
| 376J00000X | Homemaker | — | — | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | Yes |

## Other

- **Enumeration date:** 10/07/2016
- **Last updated:** 02/20/2017