MEDICARE: HOME SWEET HOME LOVING CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1396120440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME SWEET HOME LOVING CARE LLC

Provider Business Mailing Address
First Line	:	506 POPLAR VISTA LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4783
Country	:	US
Telephone Number	:	817-538-5401
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 POPLAR VISTA LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4783
Country	:	US
Telephone Number	:	817-538-5401
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. YILKA DIRIANETT VANCE
Credential	:
Telephone Number	:	817-538-5401

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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