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General NPI Number Information
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NPI Number | 1508737933
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Entity Type | Organization
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Legal Business Name | SWEETWATER LIFE
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 4311 STILLWATER VALLEY CT
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2068
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Country | US
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Telephone | 251-508-1098
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 GRANTS LAKE BLVD # 17724
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City | SUGAR LAND
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State | TX
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Zip | 77479-1255
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVONY CUNNINGHAM
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Credential |
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Telephone | 251-508-1098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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