Healthcare Provider Details

I. General information

NPI: 1134150931
Provider Name (Legal Business Name): SOUTHERNCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68853550 HULEN STREET STE B
FORT WORTH TX
76107-6885
US

IV. Provider business mailing address

2204 LAKESHORE DR SUITE 475
BIRMINGHAM AL
35209-6705
US

V. Phone/Fax

Practice location:
  • Phone: 817-763-8688
  • Fax: 817-763-8603
Mailing address:
  • Phone: 205-868-4400
  • Fax: 205-868-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number009786
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL J PARSONS
Title or Position: CEO PRESIDENT
Credential:
Phone: 205-868-4400