Provider Demographics
NPI:1881813517
Name:SMITH'S HOME FOR ADULTS
Entity type:Organization
Organization Name:SMITH'S HOME FOR ADULTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR- PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED
Authorized Official - Phone:434-685-1778
Mailing Address - Street 1:16069 MARTINSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:AXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24054-1973
Mailing Address - Country:US
Mailing Address - Phone:434-685-1778
Mailing Address - Fax:434-685-2036
Practice Address - Street 1:16069 MARTINSVILLE HWY
Practice Address - Street 2:
Practice Address - City:AXTON
Practice Address - State:VA
Practice Address - Zip Code:24054-1973
Practice Address - Country:US
Practice Address - Phone:434-685-1778
Practice Address - Fax:434-685-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARO071053104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness