1740228725 NPI number — SOUTHERN CARE INC

Table of content: (NPI 1740228725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740228725 NPI number — SOUTHERN CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN 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:
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:
1740228725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3536 VANN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-655-4809
Provider Business Mailing Address Fax Number:
205-655-0587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4330 HWY 78 EAST
Provider Second Line Business Practice Location Address:
STE 210 & 211
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-387-0249
Provider Business Practice Location Address Fax Number:
205-387-0681
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARDY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
205-655-4809

Provider Taxonomy Codes

  • Taxonomy code: 163WH1000X , with the licence number:  11076 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PIC1625E , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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