MEDICARE: SWEET HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
2	311500000X	Alzheimer Center (Dementia Center)
3	311ZA0620X	Adult Care Home Facility
4	320700000X	Physical Disabilities Residential Treatment Facility
5	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1205019080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET HOME

Provider Business Mailing Address
First Line	:	10911 CORNWALL LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3374
Country	:	US
Telephone Number	:	281-770-3751
Fax Number	:

Provider Business Practice Location Address
First Line	:	13820 EAGLE PASS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3916
Country	:	US
Telephone Number	:	281-770-3751
Fax Number	:

Authorized Official
Title or Position	:	FACILITY DIRECTOR
Name	:	MRS. KIMBERLY M SILLS
Credential	:
Telephone Number	:	281-770-3751

Provider Enumeration Date	:	12/14/2007
Last Update Date	:	12/14/2007

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Directions to “SWEET HOME ” Practice Location

Language	Start Address	Practice Location

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