MEDICARE: HOME SWEET HOME CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1699398859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME SWEET HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1717 CONGRESS ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-1982
Country	:	US
Telephone Number	:	207-653-7858
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 DELAWARE AVE
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-5916
Country	:	US
Telephone Number	:	207-653-7858
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	QAMAR AHMED
Credential	:
Telephone Number	:	207-653-7858

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	06/30/2020

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