Provider Demographics
NPI:1619163664
Name:HOME SWEET HOME UNLIMITED, INC.
Entity Type:Organization
Organization Name:HOME SWEET HOME UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:RAYNUND
Authorized Official - Last Name:WADJA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:915-857-4081
Mailing Address - Street 1:2204 JOE BATTLE BLVD
Mailing Address - Street 2:SUITE C 106
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4660
Mailing Address - Country:US
Mailing Address - Phone:915-857-4081
Mailing Address - Fax:915-857-2893
Practice Address - Street 1:2204 JOE BATTLE BLVD
Practice Address - Street 2:SUITE C 106
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4660
Practice Address - Country:US
Practice Address - Phone:915-857-4081
Practice Address - Fax:915-857-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011694251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192076101Medicaid
TX743172Medicare Oscar/Certification