Provider Demographics
NPI:1407634173
Name:ISMART HOME CARE
Entity type:Organization
Organization Name:ISMART HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:855-476-2780
Mailing Address - Street 1:1121 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2810
Mailing Address - Country:US
Mailing Address - Phone:908-445-1200
Mailing Address - Fax:
Practice Address - Street 1:100 S JUNIPER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2703
Practice Address - Country:US
Practice Address - Phone:855-476-2780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISMARTHOMECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-15
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty