| NPI | 1487240263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA M SMITH Owner 863-838-3853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse |
| Additional Taxonomies | 251E00000X Home Health |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2020-12-16 |