KEONDRA C JOHNSON (NPI# 1578179750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578179750 |
| Entity Type | Individual |
| Full Name | KEONDRA C JOHNSON |
| Practice Address |
2140 Medical District Dr Apt 2052 Dallas TX 75235-8097 |
| Mailing Address |
990 Highway 287 N Ste 106 Mansfield TX 76063-2643 |
| Practice Telephone | 2146954955 |
| Mailing Telephone | 2146954955 |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Street Address |
2140 MEDICAL DISTRICT DR APT 2052 |
| City | DALLAS |
| State | TX |
| Zip Code | 75235-8097 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265058895 | Kailey Elaine Flowers | Physical Therapy Assistant | 2400 Empire Central Drive, Suite B, Dallas, TX 75235 | 2020-06-19 |
| 1265061071 | Bella Xinyi O'malley | Student in an Organized Health Care Education/Training Program | 1935 Medical Drive, Dallas, TX 75235 | 2020-04-03 |
| 1427687318 | Can Ozlu | Student in an Organized Health Care Education/Training Program | Children's Medical Center of Dallas, 1935 Medical Distr, Dallas, TX 75235 | 2020-04-03 |
| 1689137515 | Tarek Mansi | Student in an Organized Health Care Education/Training Program | 2222 Medical District Dr Apt 4325, Dallas, TX 75235 | 2019-04-08 |
| 1386117125 | Christine Elizabeth Smith | Physician Assistant | 8134 Tex Oak Avenue, Dallas, TX 75235 | 2019-01-04 |
| 1447720016 | Michelle Angelina Dye | Physician Assistant | 5959 Maple Avenue Apt 1171, Dallas, TX 75235 | 2018-11-27 |
| 1255869335 | Andrea Nicole Pennington-peace | Specialist/Technologist, Other | 1935 Medial District, Dallas, TX 75235 | 2017-06-01 |
| 1194258152 | Tricia Rood | Student in an Organized Health Care Education/Training Program | 5200 Harry Hines Blvd., Dallas, TX 75235 | 2017-04-06 |
| 1437690971 | Robin Lee | Counselor | 8915 Hrry Hines Blvd, Dallas, TX 75235 | 2017-03-16 |
| 1871033746 | Javier Davila-lopez | Counselor | 1545 Mockingbird Lane, Suite 4000, Dallas, TX 75235 | 2017-02-27 |
| Find all providers in zip 75235 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306446000 | Daybreak, Inc. | Intermediate Care Facility, Mentally Retarded | 6520 Braddock Pl, Dallas, TX 75232-2902 | 2020-10-30 |
| 1467838540 | D&d Care Homes Texas LLC | Intermediate Care Facility, Mentally Retarded | 5218 Pershing St, Dallas, TX 75206-6524 | 2015-07-30 |
| 1144491556 | Educare Community Living Corporation - Texas | Intermediate Care Facility, Mentally Retarded | 3111 Le Harve Dr, Dallas, TX 75211-1679 | 2008-03-13 |
| 1952572364 | Educare Community Living Corporation - Texas | Intermediate Care Facility, Mentally Retarded | 5922 Lewisburg Ln, Dallas, TX 75237-2028 | 2008-03-13 |
| 1336368265 | Dallas County Mhmr | Intermediate Care Facility, Mentally Retarded | 6946 Forest Ln, Dallas, TX 75230-2304 | 2007-04-25 |
| 1053530980 | Dallas County Mhmr | Intermediate Care Facility, Mentally Retarded | 8014 Inwood Rd, Dallas, TX 75209-3336 | 2007-04-25 |
| 1659590586 | Dallas County Mhmr | Intermediate Care Facility, Mentally Retarded | 14163 Haymeadow Dr, Dallas, TX 75254-2825 | 2007-04-25 |
| 1588737159 | Evergreen Presbyterian Ministries of Texas, Inc. | Intermediate Care Facility, Mentally Retarded | 10810 Sanden Dr, Dallas, TX 75238-1337 | 2006-11-15 |
| 1912178252 | Educare Community Living Corporation - Texas | Intermediate Care Facility, Mentally Retarded | 14255 Haymeadow Dr, Dallas, TX 75254-2827 | 2008-03-14 |
| 1730350075 | Educare Community Living Corporation - Texas | Intermediate Care Facility, Mentally Retarded | 14163 Haymeadow Dr, Dallas, TX 75254-2825 | 2008-03-14 |
| Find all providers in DALLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.