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General NPI Number Information
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NPI Number | 1346924982
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Entity Type | Organization
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Legal Business Name | SWEET HOME
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 4290 E AWBREY ST
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City | MERIDIAN
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State | ID
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Zip | 83642-8683
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Country | US
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Telephone | 208-440-6545
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Fax | 208-376-2908
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Provider Business Mailing Address
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Address Line | 4290 E AWBREY ST
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City | MERIDIAN
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State | ID
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Zip | 83642-8683
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Country | US
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Telephone | 208-440-6545
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Fax | 208-376-2908
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Authorized Official
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Title or Position | OWNER
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Name | DUKE NYARECHA
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Credential |
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Telephone | 208-440-6545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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