Provider Demographics
NPI:1043040272
Name:JUNERIC, INC.
Entity type:Organization
Organization Name:JUNERIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOLESAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-213-1213
Mailing Address - Street 1:1955 N MARNITA AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7405
Mailing Address - Country:US
Mailing Address - Phone:208-213-1213
Mailing Address - Fax:
Practice Address - Street 1:1955 N MARNITA AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7405
Practice Address - Country:US
Practice Address - Phone:208-213-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care