Healthcare Provider Details

I. General information

NPI: 1922903988
Provider Name (Legal Business Name): DEAIRRA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 HAVRE ST
TOLEDO OH
43609-2732
US

IV. Provider business mailing address

370 HAVRE ST
TOLEDO OH
43609-2732
US

V. Phone/Fax

Practice location:
  • Phone: 567-315-0471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: