MEDICARE: VALERIE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)		NC

General Provider Information

NPI Number	:	1265998124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE SMITH

Provider Business Mailing Address
First Line	:	112 SHORE LAKE DR APT A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-1452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 SHORE LAKE DR APT A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-1452
Country	:	US
Telephone Number	:	336-676-4558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	02/15/2019

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Directions to “ VALERIE SMITH ” Practice Location

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