Provider Demographics
NPI:1487027181
Name:HOME SWEET ACCESSIBLE HOME, INC.
Entity Type:Organization
Organization Name:HOME SWEET ACCESSIBLE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:CAPS
Authorized Official - Phone:904-342-6844
Mailing Address - Street 1:7800 POINT MEADOWS DR
Mailing Address - Street 2:UNIT #111
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4606
Mailing Address - Country:US
Mailing Address - Phone:904-342-6844
Mailing Address - Fax:904-830-4419
Practice Address - Street 1:7800 POINT MEADOWS DR
Practice Address - Street 2:UNIT #111
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4606
Practice Address - Country:US
Practice Address - Phone:904-342-6844
Practice Address - Fax:904-830-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRC-057575171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011064200Medicaid