Provider Demographics
NPI:1740602499
Name:JOHNSON MEMORIAL HEALTH SERVICES
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HEALTH SERVICES
Other - Org Name:JOHNSON MEMORIAL ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-312-2118
Mailing Address - Street 1:1255 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232
Mailing Address - Country:US
Mailing Address - Phone:320-312-2118
Mailing Address - Fax:320-769-2972
Practice Address - Street 1:1255 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232-2333
Practice Address - Country:US
Practice Address - Phone:320-312-2118
Practice Address - Fax:320-769-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365755310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility