Provider Demographics
NPI:1104826015
Name:BARRY & JOHNSON, ASSOC, LLC
Entity Type:Organization
Organization Name:BARRY & JOHNSON, ASSOC, LLC
Other - Org Name:B & B CHRISTIAN HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-543-0681
Mailing Address - Street 1:3208 N SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-2173
Mailing Address - Country:US
Mailing Address - Phone:317-543-0681
Mailing Address - Fax:317-543-0753
Practice Address - Street 1:3208 N SHERMAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-2173
Practice Address - Country:US
Practice Address - Phone:317-543-0681
Practice Address - Fax:317-543-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155683Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER