Provider Demographics
NPI:1265970289
Name:SMITTY'S HOME HEALTH
Entity type:Organization
Organization Name:SMITTY'S HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:909-244-4280
Mailing Address - Street 1:10583 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2540
Mailing Address - Country:US
Mailing Address - Phone:909-244-4280
Mailing Address - Fax:
Practice Address - Street 1:10583 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2540
Practice Address - Country:US
Practice Address - Phone:909-244-4280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266692251E00000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health