Provider Demographics
NPI:1407634173
Name:ISMARTHOMECARE
Entity Type:Organization
Organization Name:ISMARTHOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYWAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-445-1200
Mailing Address - Street 1:1121 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2810
Mailing Address - Country:US
Mailing Address - Phone:908-445-1200
Mailing Address - Fax:
Practice Address - Street 1:2598 E SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3230
Practice Address - Country:US
Practice Address - Phone:908-445-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISMART HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty