Provider Demographics
NPI:1790138154
Name:HOME SWEET HOME ASSISTED LIVING
Entity Type:Organization
Organization Name:HOME SWEET HOME ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-618-9758
Mailing Address - Street 1:155 COUNTY ROAD 6721
Mailing Address - Street 2:
Mailing Address - City:NATALIA
Mailing Address - State:TX
Mailing Address - Zip Code:78059-2123
Mailing Address - Country:US
Mailing Address - Phone:210-618-9758
Mailing Address - Fax:
Practice Address - Street 1:155 COUNTY ROAD 6721
Practice Address - Street 2:
Practice Address - City:NATALIA
Practice Address - State:TX
Practice Address - Zip Code:78059-2123
Practice Address - Country:US
Practice Address - Phone:210-618-9758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility