Provider Demographics
NPI:1902431067
Name:HOME SWEET HOME ALF
Entity Type:Organization
Organization Name:HOME SWEET HOME ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CARLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-307-2407
Mailing Address - Street 1:36 BRONSON LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8725
Mailing Address - Country:US
Mailing Address - Phone:386-307-2407
Mailing Address - Fax:386-302-0289
Practice Address - Street 1:36 BRONSON LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8725
Practice Address - Country:US
Practice Address - Phone:386-307-2407
Practice Address - Fax:386-302-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104990100Medicaid