MEDICARE: WILLIAM 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	276400000X	Substance Use Disorder Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1720653561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOHNSON

Provider Business Mailing Address
First Line	:	4929 FOXLAIR TRL
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-2729
Country	:	US
Telephone Number	:	440-561-7381
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 MONTICELLO BLVD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-2061
Country	:	US
Telephone Number	:	440-561-7381
Fax Number	:

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

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	05/24/2021

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Directions to “ WILLIAM JOHNSON ” Practice Location

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