Provider Demographics
NPI:1083056436
Name:SWEET HOME HEALTHCARE
Entity Type:Organization
Organization Name:SWEET HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-739-1400
Mailing Address - Street 1:426 E ALLEGHENY AVE
Mailing Address - Street 2:UNIT 1 W
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2338
Mailing Address - Country:US
Mailing Address - Phone:215-739-1400
Mailing Address - Fax:215-739-1414
Practice Address - Street 1:426 E ALLEGHENY AVE
Practice Address - Street 2:UNIT 1 W
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2338
Practice Address - Country:US
Practice Address - Phone:215-739-1400
Practice Address - Fax:215-739-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05060501163W00000X, 163WH0200X, 164W00000X
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty