Provider Demographics
NPI:1942334586
Name:RAYETTA SMITH DBA SMITH AND ASSOCIATES HOME CARE
Entity Type:Organization
Organization Name:RAYETTA SMITH DBA SMITH AND ASSOCIATES HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYETTA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-359-2586
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-0432
Mailing Address - Country:US
Mailing Address - Phone:573-359-2586
Mailing Address - Fax:573-695-7905
Practice Address - Street 1:118 SOUTH THIRD ST.
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851
Practice Address - Country:US
Practice Address - Phone:573-359-2586
Practice Address - Fax:573-695-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOSM284787900Medicaid
MOSM264787904Medicaid
MO0005701OtherSSBG