Provider Demographics
NPI:1053885467
Name:SWEET HOME BELMONT LLC
Entity type:Organization
Organization Name:SWEET HOME BELMONT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:5462-AGC-14
Authorized Official - Phone:702-277-7756
Mailing Address - Street 1:2908 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6509
Mailing Address - Country:US
Mailing Address - Phone:702-473-9752
Mailing Address - Fax:702-489-9752
Practice Address - Street 1:2908 BELMONT DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6509
Practice Address - Country:US
Practice Address - Phone:702-473-9752
Practice Address - Fax:702-489-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility