Provider Demographics
NPI:1003991951
Name:SOUTHERN HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:SOUTHERN HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-0990
Mailing Address - Street 1:2925 S CARAWAY RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7313
Mailing Address - Country:US
Mailing Address - Phone:870-932-0990
Mailing Address - Fax:
Practice Address - Street 1:2925 S CARAWAY RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-932-0990
Practice Address - Fax:870-932-1124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN HOME HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49852OtherBLUE CROSS BLUE SHIEL