Individual
MRS. JENNIER RENEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRESIDENT
Contact information
Practice address
8783 2ND STREET SOUTH, BROOKSTON, MN 55711-0367
(218) 453-5062
(218) 453-5064
Mailing address
BOX 367, 8783 2ND STREET S, BROOKSTON, MN 55711-0367
(218) 453-5062
(218) 453-5064
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
354457
MN
311Z00000X
Custodial Care Facility
FBL-26096-34148
MN
311ZA0620X
Adult Care Home Facility
354448
MN
Other
Enumeration date
10/26/2011
Last updated
10/26/2011
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