Healthcare Provider Details

I. General information

NPI: 1649182908
Provider Name (Legal Business Name): DR. THOMAS JOHNSON HOUSE WITH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 W 55TH ST
MINNEAPOLIS MN
55419-1517
US

IV. Provider business mailing address

2221 W 55TH ST
MINNEAPOLIS MN
55419-1517
US

V. Phone/Fax

Practice location:
  • Phone: 612-285-8743
  • Fax: 612-922-9276
Mailing address:
  • Phone: 612-285-8743
  • Fax: 612-922-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: HEATHER BALENGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-636-0222