MEDICARE: SMARTCARE CONSULTANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	LC1263021	MO

General Provider Information

NPI Number	:	1275028094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMARTCARE CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	3565 FRANKS DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4041
Country	:	US
Telephone Number	:	855-878-3762
Fax Number	:	636-329-4527

Provider Business Practice Location Address
First Line	:	3565 FRANKS DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4041
Country	:	US
Telephone Number	:	855-878-3762
Fax Number	:	636-329-4527

Authorized Official
Title or Position	:	CMO
Name	:	MERRELL SUSAN HANSEN
Credential	:
Telephone Number	:	314-503-8844

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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