Provider Demographics
NPI:1043025760
Name:SMITH, ALLEN JR
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 REEVES RD NE APT 10
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4348
Mailing Address - Country:US
Mailing Address - Phone:330-647-3281
Mailing Address - Fax:
Practice Address - Street 1:2180 REEVES RD NE APT 10
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4348
Practice Address - Country:US
Practice Address - Phone:330-647-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant