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General NPI Number Information
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NPI Number | 1407178874
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Entity Type | Organization
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Legal Business Name | SOUTHERN ASSURED HOME HEALTH, LLC
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 640 W MAIN ST
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City | YORKTOWN
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State | TX
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Zip | 78164-5291
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Country | US
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Telephone | 210-257-5765
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Fax | 210-257-0419
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Provider Business Mailing Address
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Address Line | PO BOX 822
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City | YORKTOWN
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State | TX
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Zip | 78164-0822
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Country | US
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Telephone | 210-257-5765
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Fax | 210-257-0419
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Authorized Official
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Title or Position | CFO
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Name | MR. BARRY M WATSON
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Credential | CPA
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Telephone | 361-649-4192
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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 | 012878
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License Number State | TX
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