MEDICARE: SWEET VALLEY HOME CARE

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	311ZA0620X	Adult Care Home Facility
2	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1841904604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET VALLEY HOME CARE

Provider Business Mailing Address
First Line	:	6791 ELMDALE PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4213
Country	:	US
Telephone Number	:	702-405-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	6791 ELMDALE PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4213
Country	:	US
Telephone Number	:	702-405-7695
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRYAN WILLIAM GROSH
Credential	:
Telephone Number	:	323-710-1331

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	02/03/2023

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Directions to “SWEET VALLEY HOME CARE ” Practice Location

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