Healthcare Provider Details

I. General information

NPI: 1881874733
Provider Name (Legal Business Name): SOUTHERNCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ARENA WAY SUITE 107
COUNCIL BLUFFS IA
51501-7064
US

IV. Provider business mailing address

3536 VANN RD
BIRMINGHAM AL
35235-3221
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-4809
  • Fax: 205-655-0587
Mailing address:
  • Phone: 205-655-4809
  • Fax: 205-655-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: MICHAEL J. PARDY
Title or Position: PRESIDENT
Credential:
Phone: 205-655-4809