Provider Demographics
NPI:1588950844
Name:SMITH ADULT RESIDENTIAL CARE
Entity type:Organization
Organization Name:SMITH ADULT RESIDENTIAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-584-8451
Mailing Address - Street 1:PO BOX 1093
Mailing Address - Street 2:318-A E 4TH STREET
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1093
Mailing Address - Country:US
Mailing Address - Phone:559-584-8451
Mailing Address - Fax:559-584-8694
Practice Address - Street 1:1326 SIDONIA ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-6977
Practice Address - Country:US
Practice Address - Phone:559-589-1597
Practice Address - Fax:559-582-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility