Organization
A1 SUPPORTIVE LIVING AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAWANDA JOHNSON (OWNER)
(419) 699-6769
Entity
Organization
Contact information
Practice address
2614 W CENTRAL AVE, TOLEDO, OH 43606-3547
(419) 699-6769
Mailing address
PO BOX 70651, TOLEDO, OH 43607-0651
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Enumeration date
12/05/2023
Last updated
12/26/2024
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