Healthcare Provider Details

I. General information

NPI: 1346924982
Provider Name (Legal Business Name): SWEET HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 E AWBREY ST
MERIDIAN ID
83642-8683
US

IV. Provider business mailing address

4290 E AWBREY ST
MERIDIAN ID
83642-8683
US

V. Phone/Fax

Practice location:
  • Phone: 208-440-6545
  • Fax: 208-376-2908
Mailing address:
  • Phone: 208-440-6545
  • Fax: 208-376-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: DUKE NYARECHA
Title or Position: OWNER
Credential:
Phone: 208-440-6545