Provider Demographics
NPI:1326342890
Name:SMITH'S PERSONAL CARE HOME
Entity Type:Organization
Organization Name:SMITH'S PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-847-1093
Mailing Address - Street 1:300 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4631
Mailing Address - Country:US
Mailing Address - Phone:724-847-1093
Mailing Address - Fax:724-847-1093
Practice Address - Street 1:300 PINE ST
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4631
Practice Address - Country:US
Practice Address - Phone:724-847-1093
Practice Address - Fax:724-847-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA441830385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care