Provider Demographics
NPI:1679345987
Name:LAVENDER SMART HOMECARE, LLC
Entity Type:Organization
Organization Name:LAVENDER SMART HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZUHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FADL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-581-1588
Mailing Address - Street 1:725 SE BAYA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6073
Mailing Address - Country:US
Mailing Address - Phone:602-581-1588
Mailing Address - Fax:
Practice Address - Street 1:725 SE BAYA DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6073
Practice Address - Country:US
Practice Address - Phone:602-581-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care