Provider Demographics
NPI:1710620596
Name:SMARTLIVIN LLC
Entity Type:Organization
Organization Name:SMARTLIVIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OMONIYI
Authorized Official - Middle Name:O
Authorized Official - Last Name:TALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-603-5671
Mailing Address - Street 1:17302 N ROSA DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-1837
Mailing Address - Country:US
Mailing Address - Phone:480-603-5671
Mailing Address - Fax:
Practice Address - Street 1:17302 N ROSA DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-1837
Practice Address - Country:US
Practice Address - Phone:480-603-5671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness