=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578111233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMILES HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2019
-----------------------------------------------------
Last Update Date | 10/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 660 E 12TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16503-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-882-3134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 E 12TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16503-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-882-3134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | KADHIM ABDULZAHRA MUHSIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-882-3134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------