Provider Demographics
NPI:1184803678
Name:DIANES SWEET HOME,INC
Entity type:Organization
Organization Name:DIANES SWEET HOME,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:734-528-9881
Mailing Address - Street 1:7750 CARPENTER RD
Mailing Address - Street 2:POBOX981102
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8847
Mailing Address - Country:US
Mailing Address - Phone:734-528-9881
Mailing Address - Fax:
Practice Address - Street 1:7750 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8847
Practice Address - Country:US
Practice Address - Phone:734-528-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAS80287199OtherDEPT. OF HUMAN SERVICES