Provider Demographics
NPI:1326186966
Name:SWEET PEAS, INC.
Entity Type:Organization
Organization Name:SWEET PEAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:260-341-8230
Mailing Address - Street 1:10620 CORPORATE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1711
Mailing Address - Country:US
Mailing Address - Phone:260-341-8230
Mailing Address - Fax:260-440-8806
Practice Address - Street 1:10620 CORPORATE DR
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1711
Practice Address - Country:US
Practice Address - Phone:260-341-8230
Practice Address - Fax:260-440-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000165A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty