Provider Demographics
NPI:1104179589
Name:HOME SWEET HOME
Entity Type:Organization
Organization Name:HOME SWEET HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-209-2775
Mailing Address - Street 1:401 E MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1929
Mailing Address - Country:US
Mailing Address - Phone:920-209-2775
Mailing Address - Fax:
Practice Address - Street 1:401 E MURRAY AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1929
Practice Address - Country:US
Practice Address - Phone:920-209-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health