Healthcare Provider Details

I. General information

NPI: 1841335940
Provider Name (Legal Business Name): JOHNSON HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WALTON ST SW
WILSON NC
27893-4636
US

IV. Provider business mailing address

2401 WOOTEN BLVD SW STE B
WILSON NC
27893-4464
US

V. Phone/Fax

Practice location:
  • Phone: 252-237-9453
  • Fax:
Mailing address:
  • Phone: 252-237-9453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2869
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6601253
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier3408269
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier7804603
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 4
Identifier8301591
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 5
Identifier3409178
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 6
Identifier7804604
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: JOSIE W JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 252-237-9453