Healthcare Provider Details

I. General information

NPI: 1528003670
Provider Name (Legal Business Name): SOUTHERN IA HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BENTON AVE W
ALBIA IA
52531-1925
US

IV. Provider business mailing address

PO BOX 262
ALBIA IA
52531-0262
US

V. Phone/Fax

Practice location:
  • Phone: 641-932-7521
  • Fax: 641-932-7463
Mailing address:
  • Phone: 641-932-7521
  • Fax: 641-932-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN MARIE O'BRIEN
Title or Position: R.N./ADMINISTRATOR/OWNER
Credential: R.N.
Phone: 641-932-7521