MEDICARE: JOHNSON'S HOME CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1093675381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON'S HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2631 CECIL B MOORE AVE APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2873
Country	:	US
Telephone Number	:	240-940-8918
Fax Number	:

Provider Business Practice Location Address
First Line	:	2631 CECIL B MOORE AVE APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2873
Country	:	US
Telephone Number	:	240-940-8918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLY JOHNSON
Credential	:
Telephone Number	:	240-940-8918

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	11/18/2025

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