MEDICARE: EAARON EAARON 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	261QA0600X	Adult Day Care Clinic/Center		NM
2	374U00000X	Home Health Aide		NM

General Provider Information

NPI Number	:	1508715269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EAARON EAARON SMITH

Provider Business Mailing Address
First Line	:	1190 FASCINATION ST NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5818
Country	:	US
Telephone Number	:	505-803-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1190 FASCINATION ST NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5818
Country	:	US
Telephone Number	:	505-803-9191
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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