Healthcare Provider Details

I. General information

NPI: 1548894959
Provider Name (Legal Business Name): JOHNSON'S GENTLE CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7632 TREY RIATA DR APT 124
FORT WORTH TX
76123-4825
US

IV. Provider business mailing address

201 ARMSTRONG DR
CEDAR HILL TX
75104-2348
US

V. Phone/Fax

Practice location:
  • Phone: 318-557-2636
  • Fax:
Mailing address:
  • Phone: 817-404-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TRISHANNA T HARGROVE
Title or Position: OWNER
Credential:
Phone: 817-404-7004