Provider Demographics
NPI:1750979423
Name:SMH SPECIALIZED CARE LLC
Entity type:Organization
Organization Name:SMH SPECIALIZED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-550-1881
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:MS
Mailing Address - Zip Code:39423-0097
Mailing Address - Country:US
Mailing Address - Phone:601-550-1881
Mailing Address - Fax:
Practice Address - Street 1:110 S 27TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7156
Practice Address - Country:US
Practice Address - Phone:601-550-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care