Provider Demographics
NPI:1265015283
Name:SM FOUNDATION LLC
Entity type:Organization
Organization Name:SM FOUNDATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-706-1266
Mailing Address - Street 1:609 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3820
Mailing Address - Country:US
Mailing Address - Phone:281-706-1266
Mailing Address - Fax:366-221-0659
Practice Address - Street 1:609 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3820
Practice Address - Country:US
Practice Address - Phone:936-632-0133
Practice Address - Fax:952-241-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185OtherN/A
TX0185OtherHCS