Provider Demographics
NPI:1598913154
Name:JOHNSON SUPPORTIVE LLC
Entity Type:Organization
Organization Name:JOHNSON SUPPORTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-815-3871
Mailing Address - Street 1:5736 MANCHESTER HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-7503
Mailing Address - Country:US
Mailing Address - Phone:931-815-3871
Mailing Address - Fax:931-815-3876
Practice Address - Street 1:348 FRANK MARTIN RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7145
Practice Address - Country:US
Practice Address - Phone:931-815-3871
Practice Address - Fax:931-815-3876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3159310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility