Healthcare Provider Details

I. General information

NPI: 1023788940
Provider Name (Legal Business Name): SOUTHWOODS HEALTH AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEBARTOLO PL STE 240
YOUNGSTOWN OH
44512-7011
US

IV. Provider business mailing address

7630 SOUTHERN BLVD
YOUNGSTOWN OH
44512-5633
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-5250
  • Fax:
Mailing address:
  • Phone: 330-729-8011
  • Fax:

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. STEVEN SCOTT DAVENPORT
Title or Position: VICE PRESIDENT/COO
Credential:
Phone: 330-729-8001