=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588993133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHNSON ALLIED HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2009
-----------------------------------------------------
Last Update Date | 12/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4119 SPRING GARDEN ST STE A
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-1696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-471-9860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3215 GUESS RD SUITE 205
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27705-2665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-539-3897
-----------------------------------------------------
Fax | 919-261-6493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. SALEMATOU DIALLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-539-3990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 6601749
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------