Healthcare Provider Details

I. General information

NPI: 1215791264
Provider Name (Legal Business Name): SOUTHERN CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 HILLMAN ST
WARRENVILLE SC
29851-3148
US

IV. Provider business mailing address

187 HILLMAN ST
WARRENVILLE SC
29851-3148
US

V. Phone/Fax

Practice location:
  • Phone: 812-457-1738
  • Fax:
Mailing address:
  • Phone:
  • 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: TARA SMITH
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 812-457-1738