Healthcare Provider Details

I. General information

NPI: 1104078815
Provider Name (Legal Business Name): SOUTHERN CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MONROE ST
GRETNA LA
70053-2215
US

IV. Provider business mailing address

905 MONROE ST
GRETNA LA
70053-2215
US

V. Phone/Fax

Practice location:
  • Phone: 504-362-0376
  • Fax: 504-365-0878
Mailing address:
  • Phone: 504-362-0376
  • Fax: 504-365-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateLA

VIII. Authorized Official

Name: MISS SERNEKA A STEVENSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 504-362-0376