Provider Demographics
NPI:1053896308
Name:SOUTHERN CARE HOME HEALTH LLC
Entity type:Organization
Organization Name:SOUTHERN CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATRESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:318-527-9893
Mailing Address - Street 1:417 SURREY PL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-5991
Mailing Address - Country:US
Mailing Address - Phone:469-559-9325
Mailing Address - Fax:972-349-8962
Practice Address - Street 1:417 SURREY PL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-5991
Practice Address - Country:US
Practice Address - Phone:318-527-9893
Practice Address - Fax:972-399-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health