MEDICARE: JOHNSON CENTER HOMES, INC

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	HC3072	NC
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	078143	NC
3	251S00000X	Community/Behavioral Health Agency	HC3072	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215087044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON CENTER HOMES, INC

Provider Business Mailing Address
First Line	:	PO BOX 844
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-0844
Country	:	US
Telephone Number	:	910-843-7007
Fax Number	:	910-843-7008

Provider Business Practice Location Address
First Line	:	119 1/2 S MAIN ST
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-1511
Country	:	US
Telephone Number	:	910-843-7007
Fax Number	:	910-843-7008

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHEILA FERGUSON
Credential	:	RN
Telephone Number	:	910-843-7007

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/31/2013

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