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General NPI Number Information
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NPI Number | 1093741282
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Entity Type | Organization
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Legal Business Name | SOUTHERNCARE, INC.
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 1119 PARK AVE STE 7
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City | MEADVILLE
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State | PA
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Zip | 16335-3107
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Country | US
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Telephone | 814-336-4660
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Fax | 814-336-3378
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Provider Business Mailing Address
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Address Line | PO BOX 4060
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City | MOORESVILLE
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State | NC
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Zip | 28117-4060
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Country | US
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Telephone | 704-664-2876
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Fax | 704-664-1306
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Authorized Official
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Title or Position | VP OF LICENSURE
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Name | MS. JANET COMBS
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Credential |
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Telephone | 704-664-2876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 16811601
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License Number State | PA
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