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General NPI Number Information
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NPI Number | 1891823381
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Entity Type | Organization
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Legal Business Name | SOUTHERN CONCEPTS INC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 3451 BOSTON AVE
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City | BENBROOK
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State | TX
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Zip | 76116-6330
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Country | US
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Telephone | 817-457-7997
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 INTERNATIONAL PLZ STE 820
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City | FORT WORTH
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State | TX
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Zip | 76109-4836
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Country | US
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Telephone | 800-299-5161
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Fax |
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Authorized Official
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Title or Position | LICENSING COORDINATOR
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Name | BRANDI TURNER
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Credential |
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Telephone | 682-707-2756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 000377901
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License Number State | TX
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