Healthcare Provider Details

I. General information

NPI: 1376871939
Provider Name (Legal Business Name): SWEET COUNTRY HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 S TOPEKA AVE
CARBONDALE KS
66414-9301
US

IV. Provider business mailing address

13450 S TOPEKA AVE
CARBONDALE KS
66414-9301
US

V. Phone/Fax

Practice location:
  • Phone: 785-836-7105
  • Fax:
Mailing address:
  • Phone: 785-836-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberB070001
License Number StateKS

VIII. Authorized Official

Name: MONJICA D ORTIZ
Title or Position: OPERATOR/OWNER
Credential:
Phone: 785-836-7105