Provider Demographics
NPI:1366447799
Name:JOHNSON HOME HEALTHCARE NURSING INC
Entity Type:Organization
Organization Name:JOHNSON HOME HEALTHCARE NURSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-875-8942
Mailing Address - Street 1:1130 S EWING AVE
Mailing Address - Street 2:BLDG B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-1161
Mailing Address - Country:US
Mailing Address - Phone:903-875-8942
Mailing Address - Fax:214-948-1631
Practice Address - Street 1:1130 S EWING AVE
Practice Address - Street 2:BLDG B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-1161
Practice Address - Country:US
Practice Address - Phone:903-875-8942
Practice Address - Fax:214-948-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005184251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459445Medicare Oscar/Certification