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 38 days ago.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