Provider Demographics
NPI:1669504510
Name:SMITH RESIDENTIAL CARE
Entity Type:Organization
Organization Name:SMITH RESIDENTIAL CARE
Other - Org Name:SMITH RESIDENTIAL CARE - TERRACE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-584-8451
Mailing Address - Street 1:PO BOX 1093
Mailing Address - Street 2:318-A E. 4TH STREET
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1093
Mailing Address - Country:US
Mailing Address - Phone:559-584-8451
Mailing Address - Fax:559-584-8674
Practice Address - Street 1:1073 W TERRACE DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-1939
Practice Address - Country:US
Practice Address - Phone:559-583-7802
Practice Address - Fax:559-584-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60322HOtherMEDICAL PROVIDER NUMBER