Individual ProviderRicky C JohnsonCommunity/Behavioral HealthAgenciesPractice Address1200 S Torrey Pines Dr, Apt 156, Las Vegas, NV 89146-1013(702) 769-2313PECOS EnrollmentBased on the most recent information from CMS, provider Ricky C 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 yesterday at 11:47 AM.Profile DetailsProvider ID1073050134Provider TypeIndividualFull NameJohnson, Ricky CTitleMr.GenderMaleSole ProprietorYesEnumeration Date1/27/2017Last Updated1/27/2017Contact InformationPractice LocationPractice Address1200 S Torrey Pines Dr, Apt 156, Las Vegas, NV 89146-1013Phone(702) 769-2313FaxUnlisted FaxMailing LocationMailing Address1200 S Torrey Pines Dr, Apt 156, Las Vegas, NV 89146-1013Phone(702) 769-2313FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode251S00000XPrimaryDescriptionCommunity/Behavioral HealthAgenciesLicenseUnlisted Issuer