Provider Demographics
NPI:1558577205
Name:JOHNSON SENIOR CENTER INC
Entity Type:Organization
Organization Name:JOHNSON SENIOR CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT JOHNSON SENIOR CENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-946-2799
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-0989
Mailing Address - Country:US
Mailing Address - Phone:434-946-2799
Mailing Address - Fax:434-946-5081
Practice Address - Street 1:108 SENIOR STREET
Practice Address - Street 2:BLDG I
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-0989
Practice Address - Country:US
Practice Address - Phone:434-946-2770
Practice Address - Fax:434-946-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAR006179310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility