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General NPI Number Information
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NPI Number | 1942893250
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Entity Type | Organization
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Legal Business Name | JOHNSON ESTATE LLC
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 116 N JOHNSON ST
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City | PONTIAC
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State | MI
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Zip | 48341-1330
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Country | US
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Telephone | 248-481-7120
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Fax | 248-481-8786
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Provider Business Mailing Address
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Address Line | 116 N JOHNSON ST
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City | PONTIAC
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State | MI
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Zip | 48341-1330
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Country | US
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Telephone | 248-481-7120
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Fax | 248-481-8786
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MS. MS.KIM K YOUNG
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Credential | LLMSW
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Telephone | 248-481-7120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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