Provider Demographics
NPI:1578276697
Name:SWEET HOME ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:SWEET HOME ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENEKWEIZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-522-0235
Mailing Address - Street 1:340 N 5TH AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-4509
Mailing Address - Country:US
Mailing Address - Phone:623-522-0235
Mailing Address - Fax:480-474-4824
Practice Address - Street 1:752 E MEGAN ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3955
Practice Address - Country:US
Practice Address - Phone:480-590-2595
Practice Address - Fax:480-474-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health