Healthcare Provider Details

I. General information

NPI: 1639086861
Provider Name (Legal Business Name): CHITORA DANIELLE SMITH RESPITE PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 SLATE DR
BOILING SPRINGS SC
29316-7415
US

IV. Provider business mailing address

178 SLATE DR
BOILING SPRINGS SC
29316-7415
US

V. Phone/Fax

Practice location:
  • Phone: 864-657-0094
  • Fax:
Mailing address:
  • Phone: 864-657-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number9987826
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: