Provider Demographics
NPI:1437664125
Name:SMART CHOICE ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:SMART CHOICE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETELEHAM
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-205-1408
Mailing Address - Street 1:521 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1218
Mailing Address - Country:US
Mailing Address - Phone:612-205-1408
Mailing Address - Fax:
Practice Address - Street 1:521 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-205-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health