MEDICARE: SOUTHERN COMFORT FAMILY SERVICES

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
1	310400000X	Assisted Living Facility	AL12937	FL

General Provider Information

NPI Number	:	1619416609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN COMFORT FAMILY SERVICES

Provider Business Mailing Address
First Line	:	235 APOLLO BEACH BLVD
Second Line	:	228
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2251
Country	:	US
Telephone Number	:	813-784-7737
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 W RAVINE DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5635
Country	:	US
Telephone Number	:	813-784-7737
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. GLADYS 'LADONNA' BENNETT
Credential	:
Telephone Number	:	813-812-7799

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	02/23/2017

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Directions to “SOUTHERN COMFORT FAMILY SERVICES ” Practice Location

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