Healthcare Provider Details

I. General information

NPI: 1316619810
Provider Name (Legal Business Name): SMOOTH HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 MECHANIC ST
WESTBROOK ME
04092-2729
US

IV. Provider business mailing address

186 MECHANIC ST
WESTBROOK ME
04092-2729
US

V. Phone/Fax

Practice location:
  • Phone: 207-409-7502
  • Fax:
Mailing address:
  • Phone: 207-409-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. PIE KIDUGA
Title or Position: MEMBER
Credential:
Phone: 207-409-7502