Johnson Custodial Home, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

111923 Issued in TX

Legal business name

JOHNSON CUSTODIAL HOME, INC.

Doing business as

Maggie Johnson Nursing Center

Practice address

3406 E 17TH St
Austin, TX 78721-1106

Phone

(512) 926-4760

Fax

(512) 928-9565

NPI assigned

Jun 30, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cheryl L Killian

Title

President

Phone

(817) 654-3042

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Maggie Johnson Nursing Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407853823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 WOODSIDE DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760163030",
            "telephone_number": "817-654-3042",
            "fax_number": "817-446-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3406 E 17TH ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787211106",
            "telephone_number": "512-926-4760",
            "fax_number": "512-928-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON CUSTODIAL HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-654-3042"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "111923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4694",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maggie Johnson Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Connor Lafleur Johns
• Dylan Johns
• Judson Heidt Johns, LPC
• Rebekah Johns
• Tamara Johns
• Johnson Medical Equipment LLC
• Lindsey Brooke Johnson-Ramrez
• Janice Johnson-Simcox, COTA
• Simone Johnson-Wensink
• Abigail Johnson, CRNA

• Nursing Facility/Intermediate Care Facility in Austin, TX
• Providers in Austin, TX by specialty
• Nursing Facility/Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.