Healthcare Provider Details

I. General information

NPI: 1922939578
Provider Name (Legal Business Name): SWANK SUPPORT HOUSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15440 UTAH ST
CLEARLAKE CA
95422-8384
US

IV. Provider business mailing address

15440 UTAH ST
CLEARLAKE CA
95422-8384
US

V. Phone/Fax

Practice location:
  • Phone: 707-985-7500
  • Fax:
Mailing address:
  • Phone: 707-985-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL ANN SWANK
Title or Position: FOUNDER
Credential: CERT. ADMIN
Phone: 707-985-7500