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General NPI Number Information
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NPI Number | 1720153950
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Entity Type | Organization
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Legal Business Name | SOUTHERN HOSPITALITY HOME SUPPORT CARE
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2310 SOUTHERN AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-2260
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Country | US
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Telephone | 910-485-8003
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Fax | 910-485-8140
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Provider Business Mailing Address
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Address Line | PO BOX 64526
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-0526
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Country | US
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Telephone | 910-485-8003
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Fax | 910-485-8140
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ROSALIE P. CROWE
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Credential | RN
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Telephone | 910-485-8003
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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 | HC1088
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License Number State | NC
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