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General NPI Number Information
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NPI Number | 1134583370
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Entity Type | Organization
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Legal Business Name | SMITH STREET VILLAGE FAMILY CARE HOME, LLC
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 36 SMITH GRAVEYARD RD
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City | ASHEVILLE
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State | NC
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Zip | 28806-9655
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Country | US
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Telephone | 828-676-5600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 889
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City | MOUNTAIN HOME
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State | NC
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Zip | 28758-0889
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Country | US
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Telephone | 828-676-5600
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. NICHOLAS BRUCE STREET
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Credential | BSN, RN
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Telephone | 828-676-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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