Healthcare Provider Details

I. General information

NPI: 1508715269
Provider Name (Legal Business Name): EAARON EAARON SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 FASCINATION ST NE
RIO RANCHO NM
87144-5818
US

IV. Provider business mailing address

1190 FASCINATION ST NE
RIO RANCHO NM
87144-5818
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-9191
  • Fax:
Mailing address:
  • Phone: 505-803-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: