Provider Demographics
NPI:1912985326
Name:HOME SWEET HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:HOME SWEET HOME HEALTH CARE AGENCY
Other - Org Name:LISA MITCHELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-291-5155
Mailing Address - Street 1:11425 DORSETT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3445
Mailing Address - Country:US
Mailing Address - Phone:314-291-5155
Mailing Address - Fax:866-764-6380
Practice Address - Street 1:11425 DORSETT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3445
Practice Address - Country:US
Practice Address - Phone:314-291-5155
Practice Address - Fax:866-764-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO286220900Medicaid
MO266220904Medicaid