Provider Demographics
NPI:1801116629
Name:HENRY JOHNSON CENTER
Entity type:Organization
Organization Name:HENRY JOHNSON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-592-8521
Mailing Address - Street 1:291 E 222ND ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1718
Mailing Address - Country:US
Mailing Address - Phone:216-592-8521
Mailing Address - Fax:
Practice Address - Street 1:291 E 222ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1718
Practice Address - Country:US
Practice Address - Phone:216-592-8521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable