Provider Demographics
NPI:1942893250
Name:JOHNSON ESTATE LLC
Entity Type:Organization
Organization Name:JOHNSON ESTATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MS.KIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:248-481-7120
Mailing Address - Street 1:116 N JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1330
Mailing Address - Country:US
Mailing Address - Phone:248-481-7120
Mailing Address - Fax:248-481-8786
Practice Address - Street 1:116 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1330
Practice Address - Country:US
Practice Address - Phone:248-481-7120
Practice Address - Fax:248-481-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness