Provider Demographics
NPI:1194706283
Name:SMITHVILLE REGIONAL HOSPITAL HOME HEALTH CARE
Entity type:Organization
Organization Name:SMITHVILLE REGIONAL HOSPITAL HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-360-2002
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:701 EAST 9TH STREET
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-0568
Mailing Address - Country:US
Mailing Address - Phone:512-360-2002
Mailing Address - Fax:512-237-3385
Practice Address - Street 1:701 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1158
Practice Address - Country:US
Practice Address - Phone:512-360-2002
Practice Address - Fax:512-237-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004646251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679048Medicare ID - Type Unspecified