MEDICARE: SOUTHSIDE CAREGIVERS 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
1	251G00000X	Community Based Hospice Care Agency	PCA15152	LA

General Provider Information

NPI Number	:	1639316482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE CAREGIVERS INC.

Provider Business Mailing Address
First Line	:	1228 S WASHINGTON ST
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-4028
Country	:	US
Telephone Number	:	337-594-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 S WASHINGTON ST
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-4028
Country	:	US
Telephone Number	:	337-594-2090
Fax Number	:	337-942-8571

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. MELVIN JAMES RICHARD
Credential	:	RECREATIONAL THER
Telephone Number	:	337-308-1000

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/15/2009

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