Johnson, Gerald Bruce
Johnson, Gerald Bruce is an sole proprietor health care provider with primary practice located at 4092 W Marble Way , Wasilla AK 99654-8752. He recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as his primary health care specialty. Johnson, Gerald Bruce can be contacted via phone (907) 227-3524.Contact Information
Primary practice address
4092 W Marble Way
Wasilla AK 99654-8752
Phone: (907) 227-3524
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 320900000X | Alaska |
Profile Details
NPI number | 1609443217 |
---|---|
LBN Legal business name | Johnson, Gerald Bruce |
Credentials | |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jun 10th, 2021 |
Last updated | Jul 21st, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1609443217 | NPPES |
Alaska | MEDICAID | 1705395 |
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