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General NPI Number Information
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NPI Number | 1750979423
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Entity Type | Organization
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Legal Business Name | SMH SPECIALIZED CARE LLC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 1616 WILLIAMS DR
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City | LEAKESVILLE
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State | MS
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Zip | 39451-5622
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Country | US
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Telephone | 601-550-1881
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | BEAUMONT
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State | MS
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Zip | 39423-0097
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Country | US
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Telephone | 601-550-1881
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SHALONDA MARIE HOLLINGSWORTH
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Credential |
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Telephone | 601-550-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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