Provider Demographics
NPI:1457655623
Name:JOHNSON, ALVIN EDWARD (B/S CRIMINAL JUSTICE)
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:B/S CRIMINAL JUSTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 BARNETT AVE.
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112
Mailing Address - Country:US
Mailing Address - Phone:913-486-0472
Mailing Address - Fax:
Practice Address - Street 1:9003 BARNETT AVE.
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112
Practice Address - Country:US
Practice Address - Phone:913-486-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities