Healthcare Provider Details

I. General information

NPI: 1053150714
Provider Name (Legal Business Name): A SMILE FROM MY HEART HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 N MAIN ST STE B
SUFFOLK VA
23434-4592
US

IV. Provider business mailing address

143 N MAIN ST STE B
SUFFOLK VA
23434-4592
US

V. Phone/Fax

Practice location:
  • Phone: 757-729-3890
  • Fax: 757-942-8185
Mailing address:
  • Phone: 757-729-3890
  • Fax: 757-942-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHAWNDELL HARRIS
Title or Position: CEO
Credential:
Phone: 757-729-3890