Provider Demographics
NPI:1417723503
Name:LUCAS SMITH ENTERPRISES
Entity Type:Organization
Organization Name:LUCAS SMITH ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:KALIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCAS SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-839-2107
Mailing Address - Street 1:405 KENDRICK TER SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9109
Mailing Address - Country:US
Mailing Address - Phone:404-839-2107
Mailing Address - Fax:
Practice Address - Street 1:405 KENDRICK TER SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9109
Practice Address - Country:US
Practice Address - Phone:404-839-2107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility