=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003784471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWEETBAY MAGNOLIA SHARED LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2025
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42639 REMINISCENT LN STE B
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-518-8991
-----------------------------------------------------
Fax | 205-651-8099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42639 REMINISCENT LN STE B
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77354-7558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-518-8991
-----------------------------------------------------
Fax | 205-651-8099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ANDREA INEZ VINCENT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-518-8991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------