Organization
HOME SWEET HOME SUPPORTIVE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. T VALIANT REGISTERED NURSE-BSN (RN/OWNER)
(314) 458-8272
Entity
Organization
Contact information
Practice address
100 NORTHWEST POINT BLVD., ELK GROVE VILLAGE, IL 60007
(314) 458-8272
Mailing address
PO BOX 38085, SAINT LOUIS, MO 63138
(314) 458-8272
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
LC0914417
MO
Other
Enumeration date
08/20/2008
Last updated
04/09/2012
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