Healthcare Provider Details

I. General information

NPI: 1528642287
Provider Name (Legal Business Name): JOHNSONS COMPANIONSHIP CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 BARRACUDA RD
JACKSONVILLE FL
32244-1204
US

IV. Provider business mailing address

8220 BARRACUDA RD
JACKSONVILLE FL
32244-1204
US

V. Phone/Fax

Practice location:
  • Phone: 904-437-9278
  • Fax:
Mailing address:
  • Phone: 904-437-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORENZO JOHNSON
Title or Position: OWNER
Credential:
Phone: 904-437-9278