Provider Demographics
NPI:1598313199
Name:SMITH, BERNADETTE FRANCES (ADULT FOSTER CARE PR)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:FRANCES
Last Name:SMITH
Suffix:
Gender:F
Credentials:ADULT FOSTER CARE PR
Other - Prefix:MISS
Other - First Name:BERNADETTE
Other - Middle Name:FRANCES
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92158 CAPE ARAGO HWY,
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-8743
Mailing Address - Country:US
Mailing Address - Phone:541-888-3972
Mailing Address - Fax:
Practice Address - Street 1:92158 CAPE ARAGO HWY,
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-8743
Practice Address - Country:US
Practice Address - Phone:541-888-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5007651853104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances