Organization Name: | SUSAN BRUCE JOHNSON |
NPI Number: | 1831229483 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN BRUCE JOHNSON (ADULT FOSTER CARE PROVIDER) |
Mailing Address: | 8650 Highway 136 Borger |
State: | TX US |
Postal Code: | 79007 |
Phone Number: | 8068865244 |
Fax Number: | 8062755912 |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320700000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |