Provider Demographics
NPI:1245418052
Name:JOHNSON CENTER II
Entity Type:Organization
Organization Name:JOHNSON CENTER II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-843-7007
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0844
Mailing Address - Country:US
Mailing Address - Phone:910-843-7007
Mailing Address - Fax:910-843-7008
Practice Address - Street 1:111 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1918
Practice Address - Country:US
Practice Address - Phone:910-843-7007
Practice Address - Fax:910-843-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL078197322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children