Provider Demographics
NPI:1720815350
Name:SPECTRUM SMILES HOME INC
Entity type:Organization
Organization Name:SPECTRUM SMILES HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUERRA CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-838-2389
Mailing Address - Street 1:4801 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7206
Mailing Address - Country:US
Mailing Address - Phone:786-838-2389
Mailing Address - Fax:
Practice Address - Street 1:4801 HARRISON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7206
Practice Address - Country:US
Practice Address - Phone:786-838-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care