Provider Demographics
NPI:1508415894
Name:OUR HOME SWEET HOME LLC
Entity Type:Organization
Organization Name:OUR HOME SWEET HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TELENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-400-1717
Mailing Address - Street 1:4101 N MONTREAL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1740
Mailing Address - Country:US
Mailing Address - Phone:414-400-1717
Mailing Address - Fax:
Practice Address - Street 1:4101 N MONTREAL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1740
Practice Address - Country:US
Practice Address - Phone:414-455-3092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home