=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194039628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWEET P HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2010
-----------------------------------------------------
Last Update Date | 07/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25715 148TH DR
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11422-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-869-3595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25715 148TH DR
-----------------------------------------------------
City | ROSEDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11422-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-869-3595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN
-----------------------------------------------------
Name | JESSICA MORDI
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 347-869-3595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 626663
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------