Provider Demographics
NPI:1659630374
Name:CHRISTINE SMITH
Entity Type:Organization
Organization Name:CHRISTINE SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-675-4816
Mailing Address - Street 1:6841 PARK AVE
Mailing Address - Street 2:2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3825
Mailing Address - Country:US
Mailing Address - Phone:513-675-4816
Mailing Address - Fax:
Practice Address - Street 1:6841 PARK AVE
Practice Address - Street 2:2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3825
Practice Address - Country:US
Practice Address - Phone:513-675-4816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility