=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407911068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMART HEALTH CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 08/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6135 FAIRFIELD AVE
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71106-2743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-865-9747
-----------------------------------------------------
Fax | 318-865-9711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6135 FAIRFIELD AVE
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71106-2743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-865-9747
-----------------------------------------------------
Fax | 318-865-9711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | VALERIE HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-865-9747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 905
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------