Healthcare Provider Details

I. General information

NPI: 1316851876
Provider Name (Legal Business Name): SWEETWATER SANCTUARY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SANCTUARY LN
FREDERICK MD
21701-6807
US

IV. Provider business mailing address

3001 SANCTUARY LN
FREDERICK MD
21701-6807
US

V. Phone/Fax

Practice location:
  • Phone: 703-835-3900
  • Fax:
Mailing address:
  • Phone: 703-835-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVIN LEE HOLT
Title or Position: PRESIDENT
Credential:
Phone: 703-835-3900