Provider Demographics
NPI:1396147039
Name:SWEET PEAS
Entity type:Organization
Organization Name:SWEET PEAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:FATOUMATA
Authorized Official - Middle Name:DIARRA
Authorized Official - Last Name:DIARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-323-5824
Mailing Address - Street 1:444 MANHATTAN AVE APT 2I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1050
Mailing Address - Country:US
Mailing Address - Phone:347-323-5824
Mailing Address - Fax:
Practice Address - Street 1:444 MANHATTAN AVE APT 2I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1050
Practice Address - Country:US
Practice Address - Phone:347-323-5824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318082-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health