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General NPI Number Information
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NPI Number | 1831229483
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Entity Type | Organization
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Legal Business Name | SUSAN BRUCE JOHNSON
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8650 HIGHWAY 136
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City | BORGER
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State | TX
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Zip | 79007
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Country | US
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Telephone | 806-886-5244
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Fax | 806-275-5912
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Provider Business Mailing Address
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Address Line | PO BOX 1556 8650 HIGHWAY 136
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City | BORGER
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State | TX
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Zip | 79008-1556
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Country | US
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Telephone | 806-886-5244
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Fax | 806-275-5912
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Authorized Official
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Title or Position | ADULT FOSTER CARE PROVIDER
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Name | MRS. SUSAN BRUCE JOHNSON
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Credential |
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Telephone | 806-886-5244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | TX
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