Individual
MR. KEITH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4946 PARKSIDE AVE STE 106, PHILADELPHIA, PA 19131-4746
(267) 603-4989
Mailing address
7935 TEMPLE RD, PHILADELPHIA, PA 19150-2115
(215) 740-8854
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
55133601
PA
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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