Provider Demographics
NPI:1679638373
Name:JOHNSON, RHONDA (FOSTER PARENT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FOSTER PARENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 E CALLE ALEGRE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-2220
Mailing Address - Country:US
Mailing Address - Phone:028-329-0296
Mailing Address - Fax:
Practice Address - Street 1:2277 E CALLE ALEGRE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2220
Practice Address - Country:US
Practice Address - Phone:028-329-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11822385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child