Provider Demographics
NPI:1316005069
Name:JB JOHNSON NURSING CENTER
Entity Type:Organization
Organization Name:JB JOHNSON NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOLANGES
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-282-3102
Mailing Address - Street 1:901 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1403
Mailing Address - Country:US
Mailing Address - Phone:202-535-1100
Mailing Address - Fax:
Practice Address - Street 1:901 1ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1403
Practice Address - Country:US
Practice Address - Phone:202-535-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC095036Medicare Oscar/Certification