Provider Demographics
NPI:1740977594
Name:T J SMITH AND D GOODRICH CENTER LLC
Entity type:Organization
Organization Name:T J SMITH AND D GOODRICH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LATTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-224-7886
Mailing Address - Street 1:507 AVENUE J NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4047
Mailing Address - Country:US
Mailing Address - Phone:863-224-7886
Mailing Address - Fax:863-291-4884
Practice Address - Street 1:507 AVENUE J NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4047
Practice Address - Country:US
Practice Address - Phone:863-224-7886
Practice Address - Fax:863-291-4884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:T J SMITH AND D GOODRICH CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility