Provider Demographics
NPI:1407291503
Name:HOME SWEET HOME AT HOGAN LANE
Entity Type:Organization
Organization Name:HOME SWEET HOME AT HOGAN LANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-874-8182
Mailing Address - Street 1:1307 HOGAN LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-6616
Mailing Address - Country:US
Mailing Address - Phone:904-783-6473
Mailing Address - Fax:904-783-6473
Practice Address - Street 1:1307 HOGAN LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6616
Practice Address - Country:US
Practice Address - Phone:904-783-6473
Practice Address - Fax:904-783-6473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10443310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility