Provider Demographics
NPI:1831229483
Name:SUSAN BRUCE JOHNSON
Entity type:Organization
Organization Name:SUSAN BRUCE JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT FOSTER CARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-886-5244
Mailing Address - Street 1:PO BOX 1556
Mailing Address - Street 2:8650 HIGHWAY 136
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79008-1556
Mailing Address - Country:US
Mailing Address - Phone:806-886-5244
Mailing Address - Fax:806-275-5912
Practice Address - Street 1:8650 HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007
Practice Address - Country:US
Practice Address - Phone:806-886-5244
Practice Address - Fax:806-275-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities