Provider Demographics
NPI:1285825257
Name:HOME SWEET HOME, INC
Entity Type:Organization
Organization Name:HOME SWEET HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:LYONS
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-238-0879
Mailing Address - Street 1:508 OLD LINWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-5170
Mailing Address - Country:US
Mailing Address - Phone:336-238-0879
Mailing Address - Fax:336-238-0879
Practice Address - Street 1:508 OLD LINWOOD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-5053
Practice Address - Country:US
Practice Address - Phone:336-238-0879
Practice Address - Fax:336-238-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2195251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409532Medicaid