Provider Demographics
NPI:1326829474
Name:SMILEY BERRY LLC
Entity Type:Organization
Organization Name:SMILEY BERRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHINENYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESOMONU
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:904-290-1290
Mailing Address - Street 1:7901 4TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4399
Mailing Address - Country:US
Mailing Address - Phone:904-290-1290
Mailing Address - Fax:
Practice Address - Street 1:12724 GRAN BAY PKWY W
Practice Address - Street 2:STE 410, OFFICE 452
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-9486
Practice Address - Country:US
Practice Address - Phone:904-290-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health