Healthcare Provider Details

I. General information

NPI: 1730741604
Provider Name (Legal Business Name): SOUTHERN COMFORT HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 PARK BLVD N STE C
PINELLAS PARK FL
33781-3355
US

IV. Provider business mailing address

908 WOODBRIDGE CT
SAFETY HARBOR FL
34695-2951
US

V. Phone/Fax

Practice location:
  • Phone: 727-542-7423
  • Fax:
Mailing address:
  • Phone: 727-542-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELE TEVLIN
Title or Position: OWNER
Credential:
Phone: 727-542-7423