NPIMap

Organization Active NPI

Ronald R. Johnson

Doing business as Johnson LLHCSA Fredonia

  • Adult Care Home Facility
  • Fredonia, NY
National Provider Identifier
1780885012
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
0671A001 Issued in NY
Legal business name
RONALD R. JOHNSON
Doing business as
Johnson LLHCSA Fredonia
Practice address
4883 W Main Rd
Fredonia, NY 14063-9509
Phone
(716) 679-4883
Fax
(716) 679-4881
NPI assigned
May 31, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Dean Stanley Brown
Title
Finance Director
Phone
(716) 965-2644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 0671A001 NY Primary

Addresses

Primary practice location

4883 W Main Rd
Fredonia, NY 14063-9509

Mailing address

4883 W Main Rd
Fredonia, NY 14063-9509
Phone (716) 679-4883

Other identifiers 1

IdentifierTypeStateIssuer
01996758MedicaidNY

Other names 1

  • Johnson LLHCSA Fredonia Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Johnson Llhcsa Forestville3 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": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780885012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4883 W MAIN RD",
            "city": "FREDONIA",
            "state": "NY",
            "postal_code": "140639509",
            "telephone_number": "716-679-4883",
            "fax_number": "716-679-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4883 W MAIN RD",
            "city": "FREDONIA",
            "state": "NY",
            "postal_code": "140639509",
            "telephone_number": "716-679-4883",
            "fax_number": "716-679-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONALD R. JOHNSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "716-965-2644",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NY",
            "license": "0671A001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01996758",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson LLHCSA Fredonia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredonia, NY

Sources for this page

  • 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.