Individual ProviderGail Clarissa JohnsonCase Manager/Care CoordinatorOther Service ProvidersPractice Address6715 Dorr St, Toledo, OH 43615(419) 868-1178PECOS EnrollmentBased on the most recent information from CMS, provider Gail Clarissa Johnson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1679110209Provider TypeIndividualFull NameJohnson, Gail ClarissaCredentialRNGenderFemaleSole ProprietorYesEnumeration Date12/2/2019Last Updated11/10/2021Contact InformationPractice LocationPractice Address6715 Dorr St, Toledo, OH 43615Phone(419) 868-1178Fax(419) 868-1989Mailing LocationMailing AddressPO Box 400, Holland, OH 43528Phone(419) 868-1178Fax(419) 868-1986Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicenseRN468266OhioCode251S00000XDescriptionCommunity/Behavioral HealthAgenciesLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID0382248DescriptionMedicaidIssuerUnlistedOhio