Provider Demographics
NPI:1033153606
Name:JOHNSTON HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:JOHNSTON HEALTH SERVICES CORPORATION
Other - Org Name:SECU HOSPICE HOUSE OF JOHNSTON HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-7128
Mailing Address - Street 1:PO BOX 1376
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-1376
Mailing Address - Country:US
Mailing Address - Phone:919-209-5100
Mailing Address - Fax:919-209-5150
Practice Address - Street 1:426 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-209-5100
Practice Address - Fax:919-209-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0383251G00000X, 315D00000X
NCH054088315D00000X
NCHOS4088315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
341561Medicare ID - Type Unspecified