Provider Demographics
NPI:1033715248
Name:SOUTHERN PINES HEALTHCARE LLC
Entity Type:Organization
Organization Name:SOUTHERN PINES HEALTHCARE LLC
Other - Org Name:RESOLUTIONS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:363 N SAM HOUSTON PKWY E STE 545
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2404
Mailing Address - Country:US
Mailing Address - Phone:832-553-2276
Mailing Address - Fax:
Practice Address - Street 1:363 N SAM HOUSTON PKWY E STE 545
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2404
Practice Address - Country:US
Practice Address - Phone:832-553-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based