Healthcare Provider Details

I. General information

NPI: 1003842345
Provider Name (Legal Business Name): SOUTHERN HOME THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 2ND ST
HELENA AL
35080-3211
US

IV. Provider business mailing address

780 2ND ST
HELENA AL
35080-3211
US

V. Phone/Fax

Practice location:
  • Phone: 205-620-6775
  • Fax: 866-927-6884
Mailing address:
  • Phone: 205-620-6775
  • Fax: 866-927-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA HALECHKO
Title or Position: OWNER/OPERATOR
Credential:
Phone: 205-283-4381