Eddie Charles Smith, HOME HEALTH PROVIDER

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Practice address

21005 Highway 365 S
Little Rock, AR 72206-8964

Phone

(501) 765-4953

NPI assigned

Apr 24, 2024

Last updated

Apr 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 13

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1609622448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21005 HIGHWAY 365 S",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722068964",
            "telephone_number": "501-772-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21005 HIGHWAY 365 S",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722068964",
            "telephone_number": "501-765-4953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5111 Roundtop Dr",
            "address_purpose": "LOCATION",
            "city": "North Little Rock",
            "state": "AR",
            "postal_code": "721172187",
            "country_code": "US",
            "telephone_number": "501-772-7824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 W Avalon Dr",
            "address_purpose": "LOCATION",
            "city": "North Little Rock",
            "state": "AR",
            "postal_code": "721185103",
            "country_code": "US",
            "telephone_number": "501-772-7824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "EDDIE",
        "middle_name": "CHARLES",
        "credential": "HOME HEALTH PROVIDER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "132700000X",
            "taxonomy_group": "",
            "desc": "Dietary Manager",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "AR",
            "license": "904810414",
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dora Mah Smith, M.D.
• Douglas B Smith, M.D.
• Earl J Smith
• Earlyonna Smith
• Ebony Nicole Smith
• Emilee Ann Olivia Smith
• Emily Smith
• Emily Ellen Smith, R.D.
• Erin Smith
• Ethan Seth Smith, MD

• Assisted Living Facility (Mental Illness) in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Assisted Living Facility (Mental Illness) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.