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General NPI Number Information
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NPI Number | 1235179060
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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 | 06/08/2006
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 17316 AIRLINE HWY SUITE P
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3377
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Country | US
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Telephone | 225-673-9949
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Fax | 225-673-9954
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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 | 704-662-1306
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Authorized Official
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Title or Position | VP OF LICENSURE
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Name | JANET COMBS
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Credential |
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Telephone | 704-662-1761
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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 | 123
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License Number State | LA
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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 | 296
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License Number State | LA
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