Provider Demographics
NPI:1215087044
Name:JOHNSON CENTER HOMES, INC
Entity type:Organization
Organization Name:JOHNSON CENTER HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-843-7007
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0844
Mailing Address - Country:US
Mailing Address - Phone:910-843-7007
Mailing Address - Fax:910-843-7008
Practice Address - Street 1:119 1/2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1511
Practice Address - Country:US
Practice Address - Phone:910-843-7007
Practice Address - Fax:910-843-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3072251E00000X, 251S00000X
NC078143322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408297Medicaid
NC6603805Medicaid
NC8300663Medicaid
NC6604260Medicaid
NC3408512Medicaid
NC6601315Medicaid