Provider Demographics
NPI:1205511326
Name:ISMARTHOMECARE
Entity type:Organization
Organization Name:ISMARTHOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-476-2780
Mailing Address - Street 1:1121 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2810
Mailing Address - Country:US
Mailing Address - Phone:908-445-1200
Mailing Address - Fax:
Practice Address - Street 1:1121 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2810
Practice Address - Country:US
Practice Address - Phone:908-445-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health