1558577205 NPI number — JOHNSON SENIOR CENTER INC

Table of content: (NPI 1558577205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558577205 NPI number — JOHNSON SENIOR CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON SENIOR CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558577205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 989
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24521-0989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-946-2799
Provider Business Mailing Address Fax Number:
434-946-5081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 SENIOR STREET
Provider Second Line Business Practice Location Address:
BLDG I
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24521-0989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-946-2770
Provider Business Practice Location Address Fax Number:
434-946-5081
Provider Enumeration Date:
05/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOLAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER PRESIDENT JOHNSON SENIOR CENT
Authorized Official Telephone Number:
434-946-2799

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  R006179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)