=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831425735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING SMART, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2009
-----------------------------------------------------
Last Update Date | 10/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11681 STERLING AVE SUITE H
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-4972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-343-0657
-----------------------------------------------------
Fax | 951-343-1284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11681 STERLING AVE SUITE H
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-4972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-343-0657
-----------------------------------------------------
Fax | 951-343-1284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DENNIS R KEATS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-343-0657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------