Provider Demographics
NPI:1063943181
Name:SAVANNAH SMILES IN-HOME SERVICES LLC
Entity type:Organization
Organization Name:SAVANNAH SMILES IN-HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-304-0891
Mailing Address - Street 1:9553 WILSON BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-5238
Mailing Address - Country:US
Mailing Address - Phone:314-304-0891
Mailing Address - Fax:
Practice Address - Street 1:9553 WILSON BRIDGE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-5238
Practice Address - Country:US
Practice Address - Phone:314-304-0891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care