Provider Demographics
NPI:1295817906
Name:SMYRNA ENTERPRISES, INC
Entity Type:Organization
Organization Name:SMYRNA ENTERPRISES, INC
Other - Org Name:QUALITY CONTINUUM HOSPICE & HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:505-425-3880
Mailing Address - Street 1:518 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3716
Mailing Address - Country:US
Mailing Address - Phone:505-425-3880
Mailing Address - Fax:505-425-2929
Practice Address - Street 1:518 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3716
Practice Address - Country:US
Practice Address - Phone:505-425-3880
Practice Address - Fax:505-425-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3221251E00000X
NM3209251G00000X
NM3211251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3211OtherSTATE LICENSE
NM3221OtherSTATE LICENSE
NM3209OtherSTATE LICENSE
NM3221OtherSTATE LICENSE
NM32-1526Medicare ID - Type UnspecifiedHOSPICE
NM32-1552Medicare ID - Type UnspecifiedHOSPICE