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Organization
JOHNSON CUSTODIAL HOME, INC.
Active
Organization
JOHNSON CUSTODIAL HOME, INC.
Active
Other names
Maggie Johnson Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL L KILLIAN (PRESIDENT)
(817) 654-3042
Entity
Organization
Contact information
Practice address
3406 E 17TH ST, AUSTIN, TX 78721-1106
(512) 926-4760
(512) 928-9565
Mailing address
3801 WOODSIDE DR, ARLINGTON, TX 76016-3030
(817) 654-3042
(817) 446-3666
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
111923
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4694
—
TX
Enumeration date
06/30/2005
Last updated
08/22/2020
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