Healthcare Provider Details

I. General information

NPI: 1558300988
Provider Name (Legal Business Name): SOUTHERNCARE , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12313 WETMORE RD
SAN ANTONIO TX
78247-3635
US

IV. Provider business mailing address

655 BRAWLEY SCHOOL RD SUITE 200
MOORESVILLE NC
28117-9125
US

V. Phone/Fax

Practice location:
  • Phone: 210-490-6211
  • Fax: 210-490-5933
Mailing address:
  • Phone: 704-664-2876
  • Fax: 704-664-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number014932
License Number StateTX

VIII. Authorized Official

Name: JESSICA KLEBERG
Title or Position: VP OF LEGAL AFFAIRS
Credential:
Phone: 704-664-2876