Provider Demographics
NPI:1083151195
Name:SWEET WATERS HOMECARE, LLC
Entity Type:Organization
Organization Name:SWEET WATERS HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-330-1082
Mailing Address - Street 1:2075 N MARINE BLVD
Mailing Address - Street 2:SUITE U, #337
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5535
Mailing Address - Country:US
Mailing Address - Phone:910-319-9387
Mailing Address - Fax:
Practice Address - Street 1:130 STONEMARK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-9170
Practice Address - Country:US
Practice Address - Phone:910-330-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care