=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053642900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN LOVING CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2010
-----------------------------------------------------
Last Update Date | 01/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1804 SNAKE RIVER RD STE A
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-7744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-316-5560
-----------------------------------------------------
Fax | 888-392-0883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1804 SNAKE RIVER RD STE A
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-7744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-316-5560
-----------------------------------------------------
Fax | 888-392-0883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIAN KRIS STEWARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-316-5560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------