1295082196 NPI number — SOUTHERN HOME CARE SERVICES, INC.

Table of content: (NPI 1295082196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295082196 NPI number — SOUTHERN HOME CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HOME CARE SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TOTALCARE HOME HEALTH
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295082196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9901 LINN STATION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-394-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 JAMES ST
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06513-3089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-777-4900
Provider Business Practice Location Address Fax Number:
203-777-4916
Provider Enumeration Date:
08/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OMBRES
Authorized Official First Name:
DEENA
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
ASSOC. GEN. COUNSEL/PRIVACY OFICER
Authorized Official Telephone Number:
502-394-2100

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0036 . This is a "STATE LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008003573 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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