Provider Demographics
NPI:1023784410
Name:HOME SWEET HOME ASSISTED LIVING
Entity type:Organization
Organization Name:HOME SWEET HOME ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-692-4236
Mailing Address - Street 1:2240 RIVERDALE DR N
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3824
Mailing Address - Country:US
Mailing Address - Phone:954-692-4236
Mailing Address - Fax:
Practice Address - Street 1:2240 RIVERDALE DR N
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3824
Practice Address - Country:US
Practice Address - Phone:954-692-4236
Practice Address - Fax:754-263-7134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME SWEET HOME ALF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-17
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497189898Medicaid