Provider Demographics
NPI:1922271303
Name:SYSTEM MODILATION AND INTEGRATION FOR LIFESTYLE ENHANCEMENT
Entity Type:Organization
Organization Name:SYSTEM MODILATION AND INTEGRATION FOR LIFESTYLE ENHANCEMENT
Other - Org Name:SMILE ERS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP SALES
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLUBITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-470-9088
Mailing Address - Street 1:24000 MERCANTILE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5913
Mailing Address - Country:US
Mailing Address - Phone:216-470-9088
Mailing Address - Fax:
Practice Address - Street 1:24000 MERCANTILE RD STE 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-5913
Practice Address - Country:US
Practice Address - Phone:216-470-9088
Practice Address - Fax:216-663-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444331Medicaid