MEDICARE: MS. INDIA JOHNSON

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1215574132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. INDIA JOHNSON

Provider Business Mailing Address
First Line	:	PO BOX 121304
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41012-1304
Country	:	US
Telephone Number	:	859-466-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 FAIRMOUNT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45214-1265
Country	:	US
Telephone Number	:	812-977-7094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	09/03/2022

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