Provider Demographics
NPI:1043906175
Name:SOUTHWOOD HOME SERVICES, LLC.
Entity Type:Organization
Organization Name:SOUTHWOOD HOME SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SOUTHWOOD-LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-901-1635
Mailing Address - Street 1:4640 E ROOSEVELT BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2300
Mailing Address - Country:US
Mailing Address - Phone:267-901-1635
Mailing Address - Fax:
Practice Address - Street 1:1354 WELLS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-4922
Practice Address - Country:US
Practice Address - Phone:484-358-6379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome HealthGroup - Single Specialty