Organization
SMITH PERSONAL CARE HOME 1AND 2 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAURITA H SMITH (ADMINISTRATOR)
(478) 237-2123
Entity
Organization
Contact information
Practice address
309 ADVANCE ST, SWAINSBORO, GA 30401-3675
(478) 237-2123
(478) 237-2129
Mailing address
309 ADVANCE ST, SWAINSBORO, GA 30401-3675
(478) 237-2123
(478) 237-2129
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
053010771
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
467317926A
—
GA
Enumeration date
02/08/2012
Last updated
02/08/2012
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