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General NPI Number Information
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NPI Number | 1881813517
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Entity Type | Organization
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Legal Business Name | SMITH'S HOME FOR ADULTS
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 16069 MARTINSVILLE HWY
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City | AXTON
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State | VA
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Zip | 24054-1973
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Country | US
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Telephone | 434-685-1778
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Fax | 434-685-2036
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Provider Business Mailing Address
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Address Line | 16069 MARTINSVILLE HWY
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City | AXTON
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State | VA
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Zip | 24054-1973
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Country | US
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Telephone | 434-685-1778
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Fax | 434-685-2036
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Authorized Official
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Title or Position | ADMINISTRATOR- PRESIDENT
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Name | MR. KERRY GLENN SMITH
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Credential | LICENSED
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Telephone | 434-685-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | RO07105
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License Number State | VA
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