Provider Demographics
NPI:1023001153
Name:SOUTHERN CARE LLC
Entity Type:Organization
Organization Name:SOUTHERN CARE LLC
Other - Org Name:SUNSET MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-468-3331
Mailing Address - Street 1:251 SUNSET PL
Mailing Address - Street 2:
Mailing Address - City:GUIN
Mailing Address - State:AL
Mailing Address - Zip Code:35563-2239
Mailing Address - Country:US
Mailing Address - Phone:205-468-3331
Mailing Address - Fax:205-468-3013
Practice Address - Street 1:251 SUNSET PL
Practice Address - Street 2:
Practice Address - City:GUIN
Practice Address - State:AL
Practice Address - Zip Code:35563-2239
Practice Address - Country:US
Practice Address - Phone:205-468-3331
Practice Address - Fax:205-468-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4753190SMedicaid
5475380001Medicare NSC
AL015149Medicare Oscar/Certification