=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609269042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN TOUCH HEALTH CARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2015
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 BOULEVARD STE A
-----------------------------------------------------
City | COLONIAL HEIGHTS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23834-2323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-733-9511
-----------------------------------------------------
Fax | 804-733-9577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2801 BOULEVARD STE A
-----------------------------------------------------
City | COLONIAL HEIGHTS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23834-2323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-733-9511
-----------------------------------------------------
Fax | 804-733-9577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SUE A MOORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-733-9511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-13710
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------