Provider Demographics
NPI:1326072646
Name:SOUTHERNCARE, INC
Entity Type:Organization
Organization Name:SOUTHERNCARE, INC
Other - Org Name:SOUTHERNCAREJASPER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-868-4400
Mailing Address - Street 1:2204 LAKESHORE DR
Mailing Address - Street 2:SUITE 475
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6705
Mailing Address - Country:US
Mailing Address - Phone:205-868-4400
Mailing Address - Fax:205-868-4401
Practice Address - Street 1:4330 HIGHWAY 78 E
Practice Address - Street 2:SUITE 210 & 211
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8905
Practice Address - Country:US
Practice Address - Phone:205-387-0249
Practice Address - Fax:205-387-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11076251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1625EMedicaid
ALPIC1625EMedicaid