Organization
MICHELLE JOHNSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JOHNSON (PROVIDER)
(904) 858-9740
Entity
Organization
Contact information
Practice address
1545 PARKWOOD ST, JACKSONVILLE, FL 32207-5476
(904) 858-9740
(904) 733-2681
Mailing address
1545 PARKWOOD ST, JACKSONVILLE, FL 32207-5476
(904) 858-9740
(904) 733-2681
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
—
FL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
324500000X
Substance Abuse Rehabilitation Facility
—
FL
Other
Enumeration date
09/03/2008
Last updated
07/21/2022
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