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General NPI Number Information
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NPI Number | 1396396420
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Entity Type | Organization
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Legal Business Name | SOUTHERN CAREGIVERS, LTD
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 106 S WASHINGTON
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City | MAGNOLIA
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State | AR
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Zip | 71753-3523
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Country | US
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Telephone | 501-463-9990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 399
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City | MAGNOLIA
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State | AR
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Zip | 71754-0399
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Country | US
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Telephone | 870-904-4277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLAKE WATSON
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Credential |
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Telephone | 870-904-4277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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