Provider Demographics
NPI:1902845928
Name:JOHNSTON HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:JOHNSTON HEALTH SERVICES CORPORATION
Other - Org Name:JOHNSTON HEALTH HOME CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-7128
Mailing Address - Street 1:509 N BRIGHTLEAF BLVD
Mailing Address - Street 2:ATTN: EDDIE KLEIN, CFO
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-938-7128
Mailing Address - Fax:919-989-7297
Practice Address - Street 1:514 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 1502
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-938-7560
Practice Address - Fax:919-989-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0383251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC347105Medicare Oscar/Certification