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General NPI Number Information
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NPI Number | 1538475157
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Entity Type | Organization
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Legal Business Name | SOUTHERN COMFORTS, LLC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 118 S DIXIE AVE STE 1
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City | COOKEVILLE
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State | TN
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Zip | 38501-3415
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Country | US
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Telephone | 931-520-0968
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Fax | 931-520-0971
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Provider Business Mailing Address
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Address Line | PO BOX 695
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City | COOKEVILLE
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State | TN
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Zip | 38503-0695
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Country | US
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Telephone | 931-520-0968
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Fax | 931-520-0971
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES M TAYES
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Credential |
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Telephone | 931-372-1303
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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 | L000000006229
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License Number State | TN
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