Provider Demographics
NPI:1245234194
Name:SOUTHLAND HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHLAND HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-683-1190
Mailing Address - Street 1:9301 WALLACE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7318
Mailing Address - Country:US
Mailing Address - Phone:318-683-1190
Mailing Address - Fax:318-683-1191
Practice Address - Street 1:9301 WALLACE LAKE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7318
Practice Address - Country:US
Practice Address - Phone:318-683-1190
Practice Address - Fax:318-683-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1405019Medicaid
LA1405019Medicaid
197630Medicare Oscar/Certification
LA197630Medicare ID - Type Unspecified