Provider Demographics
NPI:1487713459
Name:JOHNSONS SENIOR MED SUPPLY CORP
Entity type:Organization
Organization Name:JOHNSONS SENIOR MED SUPPLY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATORRIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-614-3408
Mailing Address - Street 1:15332 JULIANNA
Mailing Address - Street 2:
Mailing Address - City:EAST POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:313-614-3408
Mailing Address - Fax:586-772-2719
Practice Address - Street 1:18121 EAST EIGHT MILE
Practice Address - Street 2:SUITE 110A
Practice Address - City:EAST POINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:313-614-3408
Practice Address - Fax:586-772-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies