Provider Demographics
NPI:1821786757
Name:JOHNSON STAFFING AGENCY LLC
Entity Type:Organization
Organization Name:JOHNSON STAFFING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMONIQUE
Authorized Official - Middle Name:LESHAE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:662-299-1275
Mailing Address - Street 1:522 W PARK AVE STE U
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2950
Mailing Address - Country:US
Mailing Address - Phone:662-299-1275
Mailing Address - Fax:662-214-6152
Practice Address - Street 1:522 W PARK AVE STE U
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2950
Practice Address - Country:US
Practice Address - Phone:662-299-1275
Practice Address - Fax:662-214-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care