=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013776061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWEET HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2024
-----------------------------------------------------
Last Update Date | 03/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4027 COUNTY FARM RD
-----------------------------------------------------
City | HAZLEHURST
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39083-8889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-552-1830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1426
-----------------------------------------------------
City | HAZLEHURST
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39083-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-552-1830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JACQUELINE S BALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-552-1830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------