Provider Demographics
NPI:1346924982
Name:SWEET HOME
Entity Type:Organization
Organization Name:SWEET HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYARECHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-440-6545
Mailing Address - Street 1:4290 E AWBREY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8683
Mailing Address - Country:US
Mailing Address - Phone:208-440-6545
Mailing Address - Fax:208-376-2908
Practice Address - Street 1:4290 E AWBREY ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8683
Practice Address - Country:US
Practice Address - Phone:208-440-6545
Practice Address - Fax:208-376-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility