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General NPI Number Information
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NPI Number | 1255053435
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Entity Type | Organization
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Legal Business Name | SOUTHERN COMFORT HOME HEALTH AGENCY
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 10 CANEBRAKE BLVD STE 203
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City | FLOWOOD
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State | MS
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Zip | 39232-2211
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Country | US
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Telephone | 601-850-4579
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 LAKELAND BLVD APT S192
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City | FLOWOOD
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State | MS
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Zip | 39232-8916
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Country | US
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Telephone | 601-850-4579
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXIS SHAVONE LUMPKIN
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Credential | NURSE
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Telephone | 601-850-4579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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