MEDICARE: SMITH FAMILY CARE HOMES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	311ZA0620X	Adult Care Home Facility
3	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1710148929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH FAMILY CARE HOMES

Provider Business Mailing Address
First Line	:	1801 SAN RAFAEL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4841
Country	:	US
Telephone Number	:	817-204-8462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 SAN RAFAEL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4841
Country	:	US
Telephone Number	:	817-204-8462
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TINA RENE SMITH
Credential	:
Telephone Number	:	817-204-8462

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	07/31/2008

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Directions to “SMITH FAMILY CARE HOMES ” Practice Location

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