Healthcare Provider Details

I. General information

NPI: 1003991951
Provider Name (Legal Business Name): SOUTHERN HOME HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 S CARAWAY RD
JONESBORO AR
72401
US

IV. Provider business mailing address

2925 S CARAWAY RD
JONESBORO AR
72401-7313
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-0990
  • Fax: 870-932-1124
Mailing address:
  • Phone: 870-932-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE TRICARICO
Title or Position: PRESIDENT
Credential:
Phone: 870-932-0990