Healthcare Provider Details

I. General information

NPI: 1669097283
Provider Name (Legal Business Name): SOUTHERN COMFORT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 SAINT CLAUDE AVE
NEW ORLEANS LA
70117-8455
US

IV. Provider business mailing address

2221 SAINT CLAUDE AVE
NEW ORLEANS LA
70117-8455
US

V. Phone/Fax

Practice location:
  • Phone: 504-975-1210
  • Fax: 504-648-1417
Mailing address:
  • Phone: 504-975-1210
  • Fax: 504-648-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. HOLLIS SHEPHERD
Title or Position: MANAGER
Credential:
Phone: 504-975-1210