Provider Demographics
NPI:1427067016
Name:TINA M CROSS SMOTHERS
Entity type:Organization
Organization Name:TINA M CROSS SMOTHERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEATH AID
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROSS SMOTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-455-1352
Mailing Address - Street 1:110 CLARENDON AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4623
Mailing Address - Country:US
Mailing Address - Phone:330-455-1352
Mailing Address - Fax:
Practice Address - Street 1:110 CLARENDON AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4623
Practice Address - Country:US
Practice Address - Phone:330-455-1352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2409852251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health