Healthcare Provider Details

I. General information

NPI: 1841904604
Provider Name (Legal Business Name): SWEET VALLEY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6791 ELMDALE PL
LAS VEGAS NV
89103-4213
US

IV. Provider business mailing address

6791 ELMDALE PL
LAS VEGAS NV
89103-4213
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-7695
  • Fax:
Mailing address:
  • Phone: 702-405-7695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN WILLIAM GROSH
Title or Position: PRESIDENT
Credential:
Phone: 323-710-1331