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NPI Code Detail

MEDICARE: SOUTHERNCARE, INC.

MEDICARE: SOUTHERNCARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251G00000XCommunity Based Hospice Care AgencyMS
2251G00000XCommunity Based Hospice Care Agency204MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144261850
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERNCARE, INC.
Provider Business Mailing Address
First Line : 655 BRAWLEY SCHOOL RD
Second Line : SUITE 200
City : MOORESVILLE
State : NC
Zip : 28117-9125
Country : US
Telephone Number : 704-664-2876
Fax Number : 704-662-1306
Provider Business Practice Location Address
First Line : 706 US HIGHWAY 51 NORTH
Second Line :
City : BROOKHAVEN
State : MS
Zip : 39601-2366
Country : US
Telephone Number : 601-823-4812
Fax Number : 601-833-7177
Authorized Official
Title or Position : VP OF LEGAL AFFAIRS
Name : JESSICA KLEBERG
Credential :
Telephone Number : 704-664-2876
Provider Enumeration Date : 06/10/2006
Last Update Date : 05/16/2016

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