Organization
JOHNSON HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERMAN JOHNSON (OWNER ADMINISTRATION)
(325) 985-3544
Entity
Organization
Contact information
Practice address
200 COUNTY RD 112, GOLDTHWAITE, TX 76844
(325) 985-3544
Mailing address
PO BOX 27, CR 112 #200, GOLDTHWAITE, TX 76844
(325) 985-3544
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
111856
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111856
LICENSE NUMBER
TX
01
—
24545017170001
TID
TX
01
—
45H187
FACILITY ID
TX
Enumeration date
02/21/2007
Last updated
08/22/2020
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