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General NPI Number Information
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NPI Number | 1336314038
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Entity Type | Organization
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Legal Business Name | JIMMIE L SMITH
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 18350 E HIGHWAY 105 STE A
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City | CLEVELAND
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State | TX
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Zip | 77328-2440
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Country | US
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Telephone | 281-432-1810
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Fax | 281-432-1820
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Provider Business Mailing Address
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Address Line | 17188 OAK GROVE LN
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City | NEW CANEY
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State | TX
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Zip | 77357-3391
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Country | US
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Telephone | 281-429-1838
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Fax | 281-432-1820
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | MRS. JUDY L SMITH
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Credential |
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Telephone | 281-432-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 000456
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License Number State | TX
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