Provider Demographics
NPI:1255904934
Name:JOHNSON PRIVATE HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:JOHNSON PRIVATE HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-203-6069
Mailing Address - Street 1:5499 SWEETSPRINGS DR SW STE 1
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8405
Mailing Address - Country:US
Mailing Address - Phone:770-203-6069
Mailing Address - Fax:
Practice Address - Street 1:5499 SWEETSPRINGS DR SW STE 1
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8405
Practice Address - Country:US
Practice Address - Phone:770-203-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care