Provider Demographics
NPI:1033646658
Name:SOUTHERN HOME CARE
Entity Type:Organization
Organization Name:SOUTHERN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROKIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALGHALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-849-0947
Mailing Address - Street 1:7530 LEXUS LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-9006
Mailing Address - Country:US
Mailing Address - Phone:901-849-0947
Mailing Address - Fax:
Practice Address - Street 1:7530 LEXUS LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-9006
Practice Address - Country:US
Practice Address - Phone:901-849-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care