# JOHNSON CUSTODIAL HOME, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maggie Johnson Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407853823
- **Authorized official:** CHERYL L KILLIAN (PRESIDENT)
- **Authorized official phone:** (817) 654-3042

## Contact information

- **Practice address:** 3406 E 17TH ST, AUSTIN, TX 78721-1106
- **Practice address phone:** (512) 926-4760
- **Practice address fax:** (512) 928-9565
- **Mailing address:** 3801 WOODSIDE DR, ARLINGTON, TX 76016-3030
- **Mailing address phone:** (817) 654-3042
- **Mailing address fax:** (817) 446-3666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 111923 | TX | Yes |

## Other

- **Enumeration date:** 06/30/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4694 | — | TX |