Doctor Name: | GLENNA SMITH |
NPI Number: | 1619091741 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 5972-9429 |
Business Practice Address: | 24752 Clementine Outer Rd Newburg, MO - 655509048 |
Business Phone Number: | 5737623201 |
Business Fax Number: | |
Mailing Address: | Po Box 347, NEWBURG |
State: | MO |
Postal Code: | 655500347 |
Phone Number: | 5737623201 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2007 |
NPI Last Update Date: | 02/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 5972-9429 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |