Healthcare Provider Details

I. General information

NPI: 1255467676
Provider Name (Legal Business Name): SOUTHERNCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 100TH ST SUITE 103
URBANDALE IA
50322-3857
US

IV. Provider business mailing address

2204 LAKESHORE DR SUITE 475
BIRMINGHAM AL
35209-6705
US

V. Phone/Fax

Practice location:
  • Phone: 515-727-8011
  • Fax: 515-727-0584
Mailing address:
  • Phone: 205-868-4400
  • Fax: 205-868-4401

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: MR. MICHAEL J PARSONS
Title or Position: PRESIDENT
Credential:
Phone: 205-868-4400