Provider Demographics
NPI:1528548021
Name:SISTER'S HOME STYLE ENTREES
Entity Type:Organization
Organization Name:SISTER'S HOME STYLE ENTREES
Other - Org Name:SISTER'S HOME STYLE ENTREES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-332-1928
Mailing Address - Street 1:1303 22ND ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-8896
Mailing Address - Country:US
Mailing Address - Phone:515-332-1928
Mailing Address - Fax:
Practice Address - Street 1:1303 22ND ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-8896
Practice Address - Country:US
Practice Address - Phone:515-332-1928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000220031Medicaid