Provider Demographics
NPI:1902055668
Name:JAN JOHNSON
Entity Type:Organization
Organization Name:JAN JOHNSON
Other - Org Name:FIRST STEP WALKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:218-682-2991
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-0955
Mailing Address - Country:US
Mailing Address - Phone:218-541-1100
Mailing Address - Fax:218-547-1120
Practice Address - Street 1:211 6TH ST
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-0955
Practice Address - Country:US
Practice Address - Phone:218-541-1100
Practice Address - Fax:218-547-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility