Provider Demographics
NPI:1437575008
Name:SWEETWATER LIVING, LLC
Entity Type:Organization
Organization Name:SWEETWATER LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:865-567-2397
Mailing Address - Street 1:609 CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-4707
Mailing Address - Country:US
Mailing Address - Phone:865-216-8060
Mailing Address - Fax:888-276-1061
Practice Address - Street 1:245 BUTLER DR
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1441
Practice Address - Country:US
Practice Address - Phone:423-337-9742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities