Healthcare Provider Details

I. General information

NPI: 1689735151
Provider Name (Legal Business Name): SMITHCARE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 W POPLAR AVE
PORTERVILLE CA
93257-5926
US

IV. Provider business mailing address

PO BOX 1479
PORTERVILLE CA
93258-1479
US

V. Phone/Fax

Practice location:
  • Phone: 559-784-8371
  • Fax:
Mailing address:
  • Phone: 559-784-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120000567
License Number StateCA

VIII. Authorized Official

Name: MR. MARK HANCOCK
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 559-784-5900