Healthcare Provider Details

I. General information

NPI: 1538034178
Provider Name (Legal Business Name): MR. ERNEST JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LORA AVE
YOUNGSTOWN OH
44504-1520
US

IV. Provider business mailing address

277 CRANDALL AVE APT 1
YOUNGSTOWN OH
44504-1741
US

V. Phone/Fax

Practice location:
  • Phone: 330-402-3225
  • Fax:
Mailing address:
  • Phone: 330-402-3225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: