Provider Demographics
NPI:1134414782
Name:JADA J JOHNSON MD
Entity type:Organization
Organization Name:JADA J JOHNSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-995-9600
Mailing Address - Street 1:11451 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4901
Mailing Address - Country:US
Mailing Address - Phone:773-995-9600
Mailing Address - Fax:773-995-9601
Practice Address - Street 1:11451 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4901
Practice Address - Country:US
Practice Address - Phone:773-995-9600
Practice Address - Fax:773-995-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123239251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123239Medicaid