1740285543 NPI number — SOUTHERN HOME RESPIRATORY CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740285543 NPI number — SOUTHERN HOME RESPIRATORY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HOME RESPIRATORY CARE, 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:
SLEEP SERVICES OF AMERICA, INC
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:
1740285543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 SHERATON BLVD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31210-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-757-0759
Provider Business Mailing Address Fax Number:
478-757-0799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 SHERATON BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31210-1359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-757-0759
Provider Business Practice Location Address Fax Number:
478-757-0769
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOBLEY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
SHANE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
478-757-0759

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  01977 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 310095300 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52008983001 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0094619A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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