Healthcare Provider Details

I. General information

NPI: 1194164491
Provider Name (Legal Business Name): SMITH HEALTHCARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 COTTAGE HILL RD APT A101
MOBILE AL
36606-4726
US

IV. Provider business mailing address

442 COTTAGE HILL RD APT A101
MOBILE AL
36606-4726
US

V. Phone/Fax

Practice location:
  • Phone: 251-554-3238
  • Fax:
Mailing address:
  • Phone: 251-552-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. JUDY COLLEEN SMITH
Title or Position: OWER
Credential:
Phone: 251-554-3238