Provider Demographics
NPI:1528495868
Name:JOYCIE M JOHNSON
Entity type:Organization
Organization Name:JOYCIE M JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOYCIE
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-327-2718
Mailing Address - Street 1:2698 HESTER AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-7607
Mailing Address - Country:US
Mailing Address - Phone:321-327-2718
Mailing Address - Fax:321-727-8811
Practice Address - Street 1:2698 HESTER AVE SE
Practice Address - Street 2:SAME
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-7607
Practice Address - Country:US
Practice Address - Phone:321-327-2718
Practice Address - Fax:321-727-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906635311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home