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General NPI Number Information
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NPI Number | 1639316482
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE CAREGIVERS INC.
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 1228 S WASHINGTON ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-4028
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Country | US
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Telephone | 337-594-2090
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Fax | 337-942-8571
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Provider Business Mailing Address
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Address Line | 1228 S WASHINGTON ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-4028
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Country | US
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Telephone | 337-594-2090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MELVIN JAMES RICHARD
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Credential | RECREATIONAL THER
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Telephone | 337-308-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | PCA15152
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License Number State | LA
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