Healthcare Provider Details

I. General information

NPI: 1922287770
Provider Name (Legal Business Name): SMITHFIELD HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 HOSPITAL RD
SMITHFIELD NC
27577-4101
US

IV. Provider business mailing address

PO BOX 269
SMITHFIELD NC
27577-0269
US

V. Phone/Fax

Practice location:
  • Phone: 828-738-3046
  • Fax: 828-738-0350
Mailing address:
  • Phone: 919-934-7708
  • Fax: 919-989-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL 051-027
License Number StateNC

VIII. Authorized Official

Name: KENNETH R HODGES
Title or Position: MEMBER/MANAGER
Credential: ADMINISTRATOR
Phone: 828-738-3046