MEDICARE: SMITH'S HOME FOR ADULTS

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	3104A0625X	Assisted Living Facility (Mental Illness)	RO07105	VA

General Provider Information

NPI Number	:	1881813517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH'S HOME FOR ADULTS

Provider Business Mailing Address
First Line	:	16069 MARTINSVILLE HWY
Second Line	:
City	:	AXTON
State	:	VA
Zip	:	24054-1973
Country	:	US
Telephone Number	:	434-685-1778
Fax Number	:	434-685-2036

Provider Business Practice Location Address
First Line	:	16069 MARTINSVILLE HWY
Second Line	:
City	:	AXTON
State	:	VA
Zip	:	24054-1973
Country	:	US
Telephone Number	:	434-685-1778
Fax Number	:	434-685-2036

Authorized Official
Title or Position	:	ADMINISTRATOR- PRESIDENT
Name	:	MR. KERRY GLENN SMITH
Credential	:	LICENSED
Telephone Number	:	434-685-1778

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/15/2014

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Directions to “SMITH'S HOME FOR ADULTS ” Practice Location

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