=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457305971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN QUALITY HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 03/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 MANHATTTAN BLVD. SUITE #18
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-364-8014
-----------------------------------------------------
Fax | 504-364-8054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2701 MANHATTTAN BLVD. SUITE #18
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-364-8014
-----------------------------------------------------
Fax | 504-364-8054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CFO
-----------------------------------------------------
Name | MRS. KIMBERLY L TERHUNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-364-8014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 486
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------