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General NPI Number Information
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NPI Number | 1477754703
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Entity Type | Organization
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Legal Business Name | RONALD R. JOHNSON
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2063 ROUTE 83
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City | FORESTVILLE
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State | NY
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Zip | 14062-9639
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Country | US
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Telephone | 716-965-2644
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Fax |
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Provider Business Mailing Address
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Address Line | 2063 ROUTE 83
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City | FORESTVILLE
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State | NY
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Zip | 14062-9639
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Country | US
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Telephone | 716-965-2644
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Fax |
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Authorized Official
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Title or Position | FINANCE DIRECTOR
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Name | MR. DEAN STANLEY BROWN
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Credential |
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Telephone | 716-965-2644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 0671A002
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License Number State | NY
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