Provider Demographics
NPI:1639498892
Name:SWEET HOME REHAB INC
Entity Type:Organization
Organization Name:SWEET HOME REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MPT
Authorized Official - Prefix:MS
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-439-2883
Mailing Address - Street 1:313 HUNTINGTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 HUNTINGTON
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-5729
Practice Address - Country:US
Practice Address - Phone:949-439-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23120320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities