Healthcare Provider Details

I. General information

NPI: 1164634085
Provider Name (Legal Business Name): HOME SWEET HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 3RD AVE
CHESAPEAKE OH
45619
US

IV. Provider business mailing address

304 3RD AVE
CHESAPEAKE OH
45619
US

V. Phone/Fax

Practice location:
  • Phone: 740-867-4160
  • Fax: 740-867-4162
Mailing address:
  • Phone: 740-867-4160
  • Fax: 740-867-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. PHYLLIS ANN COPLEY
Title or Position: ADM OWNER
Credential:
Phone: 740-867-4160