Provider Demographics
NPI:1114368347
Name:SMITH, PATRICE HELEN (LPT)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:HELEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8074
Mailing Address - Country:US
Mailing Address - Phone:740-708-0552
Mailing Address - Fax:
Practice Address - Street 1:405 NORTH PARK AVE
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-1930
Practice Address - Country:US
Practice Address - Phone:740-384-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT8079314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility