Healthcare Provider Details

I. General information

NPI: 1154692200
Provider Name (Legal Business Name): SANETA SMITH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2012
Last Update Date: 01/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ARBOR CT
CINCINNATI OH
45246-2301
US

IV. Provider business mailing address

13 ARBOR CT
CINCINNATI OH
45246-2301
US

V. Phone/Fax

Practice location:
  • Phone: 513-257-0724
  • Fax:
Mailing address:
  • Phone: 513-257-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberMBS#3111822
License Number StateOH

VIII. Authorized Official

Name: MS. SANETA FLORES SMITH
Title or Position: INDEPENDENT PROVIDER
Credential:
Phone: 513-257-0724