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General NPI Number Information
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NPI Number | 1912945395
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Entity Type | Organization
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Legal Business Name | SOUTHERNCARE, INC.
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 620 GUILBEAU RD SUITE A
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City | LAFAYETTE
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State | LA
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Zip | 70506-8709
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Country | US
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Telephone | 337-291-1818
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Fax | 337-291-1813
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Provider Business Mailing Address
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Address Line | 655 BRAWLEY SCHOOL RD SUITE 200
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City | MOORESVILLE
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State | NC
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Zip | 28117-9125
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Country | US
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Telephone | 704-664-2876
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Fax | 704-664-1306
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Authorized Official
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Title or Position | VP OF LEGAL AFFAIRS
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Name | JESSICA KLEBERG
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Credential |
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Telephone | 704-664-2876
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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 | 124
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2203781648
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License Number State | LA
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