1841730181 NPI number — SOUTHERN CARE CONNECTION, LLC

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 1841730181 NPI number — SOUTHERN CARE CONNECTION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN CARE CONNECTION, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1841730181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4512 BURKE DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-652-1847
Provider Business Mailing Address Fax Number:
985-652-1897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 W AIRLINE HWY, SUITE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-652-1847
Provider Business Practice Location Address Fax Number:
985-652-1897
Provider Enumeration Date:
03/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MAYEAUX
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
985-652-1847

Provider Taxonomy Codes

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

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

  • Identifier: 1821063 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1813532 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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