=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720871908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN GRACE HOME HEALTH & HOSPICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2025
-----------------------------------------------------
Last Update Date | 06/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6510 GAINES ST
-----------------------------------------------------
City | EIGHT MILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36613-8350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-753-4827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6510 GAINES ST
-----------------------------------------------------
City | EIGHT MILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36613-8350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-753-4827
-----------------------------------------------------
Fax | 251-753-4827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MATTHEW L ARMSTRONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-753-4827
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------