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General NPI Number Information
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NPI Number | 1962734277
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Entity Type | Organization
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Legal Business Name | SOUTHERN CARE STAFFING LLC
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 1450 N MACK SMITH RD SUITE A
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City | EAST RIDGE
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State | TN
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Zip | 37412-3948
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Country | US
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Telephone | 423-752-5002
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 N MACK SMITH RD SUITE A
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City | EAST RIDGE
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State | TN
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Zip | 37412-3948
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Country | US
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Telephone | 423-752-5002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD C LUSK
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Credential |
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Telephone | 423-595-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 385H00000X
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License Number State | TN
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