Provider Demographics
NPI:1902485113
Name:SMART START INDEPENDENT LIVING LLC
Entity Type:Organization
Organization Name:SMART START INDEPENDENT LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALL MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-596-5999
Mailing Address - Street 1:1550 W HORIZON RIDGE PKWY # R579
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3600
Mailing Address - Country:US
Mailing Address - Phone:760-596-5999
Mailing Address - Fax:
Practice Address - Street 1:1550 W HORIZON RIDGE PKWY # R579
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3600
Practice Address - Country:US
Practice Address - Phone:760-596-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase ManagementGroup - Single Specialty