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General NPI Number Information
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NPI Number | 1295817906
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Entity Type | Organization
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Legal Business Name | SMYRNA ENTERPRISES, INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 518 VALENCIA ST
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City | LAS VEGAS
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State | NM
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Zip | 87701-3716
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Country | US
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Telephone | 505-425-3880
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Fax | 505-425-2929
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Provider Business Mailing Address
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Address Line | 518 VALENCIA ST
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City | LAS VEGAS
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State | NM
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Zip | 87701-3716
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Country | US
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Telephone | 505-425-3880
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Fax | 505-425-2929
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JUSTIN O SMITH
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Credential | OWNER
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Telephone | 505-425-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3221
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 3211
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 3209
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License Number State | NM
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