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General NPI Number Information
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NPI Number | 1629726583
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Entity Type | Individual
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Provider Name | LEIGHANN JOHNSON GROUP HOME OWNER
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Gender | Female
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1958 E RENEGADE TRL
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-4460
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Country | US
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Telephone | 928-250-9436
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Fax |
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Provider Business Mailing Address
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Address Line | 270 E HUNT HWY STE 16-226
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-6011
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Country | US
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Telephone | 928-250-9436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | AZ
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