Healthcare Provider Details

I. General information

NPI: 1548395098
Provider Name (Legal Business Name): JOHNSONS CLIENT CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4038 MARION PL
SHREVEPORT LA
71109-5012
US

IV. Provider business mailing address

4038 MARION PL
SHREVEPORT LA
71109-5012
US

V. Phone/Fax

Practice location:
  • Phone: 318-631-7714
  • Fax: 318-636-7614
Mailing address:
  • Phone: 318-631-7714
  • Fax: 318-636-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11791 AND 11792
License Number StateLA

VIII. Authorized Official

Name: MS. DIRECT OWNER CHIEF EXECUTIVE OFFI DIRECTOR
Title or Position: DIRECTOR
Credential: M
Phone: 318-631-7714