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NPI Code Detail

MEDICARE: DE'ANDRE SMITH

MEDICARE: DE'ANDRE 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
1376J00000XHomemaker
2385HR2060XChild Intellectual and/or Developmental Disabilities Respite Care
3372600000XAdult Companion

General Provider Information

NPI Number : 1588463640
Entity Type Code : Individual
Provider Name (Legal Business Name) : DE'ANDRE SMITH
Provider Business Mailing Address
First Line : 6818 GROVER ST STE 200
Second Line :
City : OMAHA
State : NE
Zip : 68106-3632
Country : US
Telephone Number : 402-932-0072
Fax Number : 402-614-8245
Provider Business Practice Location Address
First Line : 6544 N 34TH ST
Second Line :
City : OMAHA
State : NE
Zip : 68112-3024
Country : US
Telephone Number : 402-505-0614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2025
Last Update Date : 03/11/2025

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Directions to “ DE'ANDRE SMITH ” Practice Location

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