Provider Demographics
NPI:1295376283
Name:SWEET FAMILY CARE AT HOME, LLC
Entity Type:Organization
Organization Name:SWEET FAMILY CARE AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENJIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-347-4300
Mailing Address - Street 1:645 60TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1381
Mailing Address - Country:US
Mailing Address - Phone:347-430-0934
Mailing Address - Fax:
Practice Address - Street 1:645 60TH ST APT 6
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1381
Practice Address - Country:US
Practice Address - Phone:347-430-0934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1376195933Medicaid