Provider Demographics
NPI:1043642176
Name:SOUTHERN CARE SERVICES, LLC.
Entity Type:Organization
Organization Name:SOUTHERN CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDE T
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-957-0099
Mailing Address - Street 1:2738 WINNETKA AVE N
Mailing Address - Street 2:SUITE #150Q
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2850
Mailing Address - Country:US
Mailing Address - Phone:763-957-0099
Mailing Address - Fax:952-217-4513
Practice Address - Street 1:2738 WINNETKA AVE N
Practice Address - Street 2:SUITE #150Q
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2850
Practice Address - Country:US
Practice Address - Phone:763-957-0099
Practice Address - Fax:952-217-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health