Provider Demographics
NPI:1336688191
Name:THE JOHNSON FOUNDATION INC.
Entity Type:Organization
Organization Name:THE JOHNSON FOUNDATION INC.
Other - Org Name:THE HARP INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF BEHAVIORAL COUNSELING
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DBC
Authorized Official - Phone:760-596-3803
Mailing Address - Street 1:14619 MAVERICK PL
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7082
Mailing Address - Country:US
Mailing Address - Phone:760-596-3803
Mailing Address - Fax:760-596-3803
Practice Address - Street 1:16755 HUGHES RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4563
Practice Address - Country:US
Practice Address - Phone:760-684-3419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE JOHNSON FOUNDATION INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAJ1006181711324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========0OtherBEHAVIORAL COUNSELING