Healthcare Provider Details

I. General information

NPI: 1821786757
Provider Name (Legal Business Name): JOHNSON STAFFING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W PARK AVE STE U
GREENWOOD MS
38930-2950
US

IV. Provider business mailing address

522 W PARK AVE STE U
GREENWOOD MS
38930-2950
US

V. Phone/Fax

Practice location:
  • Phone: 662-299-1275
  • Fax: 662-214-6152
Mailing address:
  • Phone: 662-299-1275
  • Fax: 662-214-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. DOMONIQUE LESHAE JOHNSON
Title or Position: CEO
Credential: LPN
Phone: 662-299-1275