NPIMap

Organization Active NPI

Johnson Home Assisted Living, Inc.

  • Assisted Living Facility (Mental Illness)
  • Pueblo, CO
National Provider Identifier
1447615968
Registry record updated Dec 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
License
230602 Issued in CO
Legal business name
JOHNSON HOME ASSISTED LIVING, INC.
Practice address
403 W 13TH St
Pueblo, CO 81003-2748
Phone
(719) 543-0306
Fax
(719) 562-9684
NPI assigned
Dec 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2015

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

Authorized official

Name
Mr. Paul Spicola
Title
Vice-President
Phone
(719) 369-4567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X 230602 CO Primary

Addresses

Primary practice location

403 W 13TH St
Pueblo, CO 81003-2748

Mailing address

403 W 13TH St
Pueblo, CO 81003-2748
Phone (719) 543-0306

Other identifiers 1

IdentifierTypeStateIssuer
04142097MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Johnson Home Assisted Living Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1451260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451347200000",
    "number": "1447615968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 W 13TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032748",
            "telephone_number": "719-543-0306",
            "fax_number": "719-562-9684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 W 13TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032748",
            "telephone_number": "719-543-0306",
            "fax_number": "719-562-9684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON HOME ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-28",
        "last_updated": "2015-12-29",
        "status": "A",
        "authorized_official_last_name": "SPICOLA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "719-369-4567",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "CO",
            "license": "230602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04142097",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; 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.