MEDICARE: ZURIEL SMITH

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	2383	VA
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	2383	VA

General Provider Information

NPI Number	:	1336530674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZURIEL SMITH

Provider Business Mailing Address
First Line	:	115 LURAY DRIVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23227-2046
Country	:	US
Telephone Number	:	804-517-3769
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 LURAY DRIVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23227-2046
Country	:	US
Telephone Number	:	804-517-3769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/10/2015

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Directions to “ ZURIEL SMITH ” Practice Location

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