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General NPI Number Information
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NPI Number | 1275925984
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Entity Type | Organization
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Legal Business Name | SOUTHERN HOME CARE ASSISTANCE
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 2836 MALVERN AVE STE G
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8363
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Country | US
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Telephone | 501-525-8886
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Fax | 501-525-8887
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Provider Business Mailing Address
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Address Line | 2836 MALVERN AVE STE G
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8363
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STACEY R PHILYAW
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Credential |
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Telephone | 501-525-8886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | AR
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