Healthcare Provider Details

I. General information

NPI: 1720316292
Provider Name (Legal Business Name): SMILE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2009
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 MAHONING AVE NW
WARREN OH
44484-2830
US

IV. Provider business mailing address

669 MAHONING AVE NW
WARREN OH
44483-4607
US

V. Phone/Fax

Practice location:
  • Phone: 330-469-5444
  • Fax:
Mailing address:
  • Phone: 330-307-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT JAMES NICHOLSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 330-307-9806