Provider Demographics
NPI:1992567721
Name:SWEET HOME MC LLC
Entity type:Organization
Organization Name:SWEET HOME MC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-391-9999
Mailing Address - Street 1:650 HAWTHORNE AVE SE STE 210
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5895
Mailing Address - Country:US
Mailing Address - Phone:503-391-9999
Mailing Address - Fax:
Practice Address - Street 1:4950 MOUNTAIN FIR ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386
Practice Address - Country:US
Practice Address - Phone:503-391-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)