Provider Demographics
NPI:1336314038
Name:JIMMIE L SMITH
Entity Type:Organization
Organization Name:JIMMIE L SMITH
Other - Org Name:J & D PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-432-1810
Mailing Address - Street 1:17188 OAK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-3391
Mailing Address - Country:US
Mailing Address - Phone:281-429-1838
Mailing Address - Fax:281-432-1820
Practice Address - Street 1:18350 E HIGHWAY 105 STE A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77328-2440
Practice Address - Country:US
Practice Address - Phone:281-432-1810
Practice Address - Fax:281-432-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000456320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities