Provider Demographics
NPI:1962690891
Name:MELVIN AND JOHNSON COMMUNITY LIVING
Entity type:Organization
Organization Name:MELVIN AND JOHNSON COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:CHECRECE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-818-8797
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0851
Mailing Address - Country:US
Mailing Address - Phone:910-843-3659
Mailing Address - Fax:910-843-3659
Practice Address - Street 1:169 FRONT ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1713
Practice Address - Country:US
Practice Address - Phone:910-843-3659
Practice Address - Fax:910-843-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-195322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children