Healthcare Provider Details

I. General information

NPI: 1184258485
Provider Name (Legal Business Name): SOUTHERN COMFORT IN-HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26091 SHOEMAKER RD
ANDALUSIA AL
36421-5903
US

IV. Provider business mailing address

26091 SHOEMAKER RD
ANDALUSIA AL
36421-5903
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-0100
  • Fax:
Mailing address:
  • Phone: 334-222-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BLOCKER
Title or Position: PRESIDENT
Credential:
Phone: 334-222-0100