=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861626582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN BELLES HOME SWEET HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2009
-----------------------------------------------------
Last Update Date | 01/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 812 1/2 W 44TH ST UPPER
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31405-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-238-8283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 1/2 WEST 44TH STREET UPPER
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31405-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-610-0001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTATOR
-----------------------------------------------------
Name | MS. ALVINA MICHELLE DIXON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-610-0001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------