Basic Information
| Provider Information | |||||||||
| NPI: | 1740228725 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHERN CARE JASPER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3536 VANN ROAD | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056554809 | ||||||||
| FaxNumber: | 2056550587 | ||||||||
| Practice Location | |||||||||
| Address1: | 4330 HWY 78 EAST | ||||||||
| Address2: | STE 210 & 211 | ||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053870249 | ||||||||
| FaxNumber: | 2053870681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PARDY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2056554809 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH1000X | 11076 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Hospice |
ID Information
| ID | Type | State | Issuer | Description | PIC1625E | 05 | AL | MEDICAID |