Provider Demographics
NPI:1821133422
Name:JOHNSON HOME
Entity Type:Organization
Organization Name:JOHNSON HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-985-3544
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:CR 112 #200
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844
Mailing Address - Country:US
Mailing Address - Phone:325-985-3544
Mailing Address - Fax:
Practice Address - Street 1:200 COUNTY RD 112
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844
Practice Address - Country:US
Practice Address - Phone:325-985-3544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111856315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111856OtherLICENSE NUMBER
TX45H187OtherFACILITY ID
TX24545017170001OtherTID