MEDICARE: JOYCIE M 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	311ZA0620X	Adult Care Home Facility	6906635	FL

General Provider Information

NPI Number	:	1528495868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYCIE M JOHNSON

Provider Business Mailing Address
First Line	:	2698 HESTER AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-7607
Country	:	US
Telephone Number	:	321-327-2718
Fax Number	:	321-727-8811

Provider Business Practice Location Address
First Line	:	2698 HESTER AVE SE
Second Line	:	SAME
City	:	PALM BAY
State	:	FL
Zip	:	32909-7607
Country	:	US
Telephone Number	:	321-327-2718
Fax Number	:	321-727-8811

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MISS JOYCIE MAY JOHNSON
Credential	:
Telephone Number	:	321-327-2718

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	01/23/2014

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