Provider Demographics
NPI:1972667400
Name:JOHNSON'S PERSONAL CARE HOME, INC.
Entity Type:Organization
Organization Name:JOHNSON'S PERSONAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:TAMIKA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:229-246-2420
Mailing Address - Street 1:1007 HALL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4693
Mailing Address - Country:US
Mailing Address - Phone:229-246-2420
Mailing Address - Fax:246-246-2424
Practice Address - Street 1:1007 HALL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4693
Practice Address - Country:US
Practice Address - Phone:229-246-2420
Practice Address - Fax:246-246-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness