Healthcare Provider Details

I. General information

NPI: 1205019080
Provider Name (Legal Business Name): SWEET HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13820 EAGLE PASS ST
HOUSTON TX
77015-3916
US

IV. Provider business mailing address

10911 CORNWALL LN
MISSOURI CITY TX
77459-3374
US

V. Phone/Fax

Practice location:
  • Phone: 281-770-3751
  • Fax:
Mailing address:
  • Phone: 281-770-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY M SILLS
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 281-770-3751