Healthcare Provider Details

I. General information

NPI: 1003470964
Provider Name (Legal Business Name): SMILEY PRIVATE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 ANN ARBOR RD #249
PLYMOUTH MI
48170
US

IV. Provider business mailing address

PO BOX 651
GRAND BLANC MI
48480
US

V. Phone/Fax

Practice location:
  • Phone: 810-423-2318
  • Fax: 248-939-5875
Mailing address:
  • Phone: 810-423-2318
  • Fax: 248-939-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL RUTH WILSON
Title or Position: OWNER
Credential:
Phone: 810-423-2318