Individual
EDDIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
338 BOND ST, LONE STAR, TX 75668-0230
(903) 646-3171
(903) 646-0512
Mailing address
PO BOX 124, LONE STAR, TX 75668-0124
(903) 646-3171
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/19/2017
Last updated
10/19/2017
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