Healthcare Provider Details

I. General information

NPI: 1083056436
Provider Name (Legal Business Name): SWEET HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 E ALLEGHENY AVE UNIT 1 W
PHILADELPHIA PA
19134-2338
US

IV. Provider business mailing address

426 E ALLEGHENY AVE UNIT 1 W
PHILADELPHIA PA
19134-2338
US

V. Phone/Fax

Practice location:
  • Phone: 215-739-1400
  • Fax: 215-739-1414
Mailing address:
  • Phone: 215-739-1400
  • Fax: 215-739-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number05060501
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number05060501
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number05060501
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StatePA

VIII. Authorized Official

Name: MRS. TEKIA EZELL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 215-739-1400