Healthcare Provider Details

I. General information

NPI: 1457749673
Provider Name (Legal Business Name): S SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 LORAIN AVE
CLEVELAND OH
44102-4753
US

IV. Provider business mailing address

PO BOX 1873
MEDINA OH
44258-1873
US

V. Phone/Fax

Practice location:
  • Phone: 216-369-7119
  • Fax: 216-920-9973
Mailing address:
  • Phone: 216-369-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number4545
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberSC.7149
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSC.7149
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.157757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: