Provider Demographics
NPI:1902146921
Name:RONNETTE SMITH
Entity Type:Organization
Organization Name:RONNETTE SMITH
Other - Org Name:SMITH FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONNETTE
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-655-9827
Mailing Address - Street 1:492 SPEARMAN RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:NC
Mailing Address - Zip Code:28423-8622
Mailing Address - Country:US
Mailing Address - Phone:910-655-9827
Mailing Address - Fax:
Practice Address - Street 1:492 SPEARMAN RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:NC
Practice Address - Zip Code:28423-8622
Practice Address - Country:US
Practice Address - Phone:910-655-9827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL024014311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home