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General NPI Number Information
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NPI Number | 1245018563
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Entity Type | Organization
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Legal Business Name | SMARTBASIL, LLC
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1001 OBICI INDUSTRIAL BLVD STE G
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City | SUFFOLK
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State | VA
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Zip | 23434-5480
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Country | US
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Telephone | 757-809-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 OBICI INDUSTRIAL BLVD STE G
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City | SUFFOLK
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State | VA
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Zip | 23434-5480
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Country | US
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Telephone | 757-809-3577
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN TRANT
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Credential |
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Telephone | 757-809-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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