Healthcare Provider Details

I. General information

NPI: 1043642176
Provider Name (Legal Business Name): SOUTHERN CARE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2738 WINNETKA AVE N SUITE #150Q
NEW HOPE MN
55427-2850
US

IV. Provider business mailing address

2738 WINNETKA AVE N SUITE #150Q
NEW HOPE MN
55427-2850
US

V. Phone/Fax

Practice location:
  • Phone: 763-957-0099
  • Fax: 952-217-4513
Mailing address:
  • Phone: 763-957-0099
  • Fax: 952-217-4513

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: MR. TIMOTHY WAYNE FOSTER
Title or Position: PRESIDE T
Credential:
Phone: 763-957-0099