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SOUTHERN HOME CARE

Intermediate Care Mentally Retarded

Cordele, Georgia

Provider NPI: 1063746204

Organization Information:
Organization Name:  SOUTHERN HOME CARE
Organization is not Subpart
Authorized Official:  DEENA  OMBRES  PRIVACY OFFICER  502-3942387

Practice Location:
701 S 3RD ST  CORDELE, GA 31015 US
Tel: 229-242-2797  Fax: --

Business Mailing Address:
9901 LINN STATION RD  LOUISVILLE, KY 40223 US
Tel: 800-866-0860  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
GA

Other Provider Identifiers:

IssuerNumberStateType
000552538BIGA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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