Provider Demographics
NPI:1669864625
Name:HOME SWEET HOME SUPPORTIVE LIVING INC.
Entity Type:Organization
Organization Name:HOME SWEET HOME SUPPORTIVE LIVING INC.
Other - Org Name:HOME SWEET HOME ASSISTED LIVING INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-834-6979
Mailing Address - Street 1:533 TURTLE XING
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9325
Mailing Address - Country:US
Mailing Address - Phone:423-619-1234
Mailing Address - Fax:423-893-5273
Practice Address - Street 1:1618 GUNBARREL RD
Practice Address - Street 2:103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4134
Practice Address - Country:US
Practice Address - Phone:423-619-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN057920311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home