Provider Demographics
NPI:1376848986
Name:SOUTH REGION HEALTHCARE LLC
Entity Type:Organization
Organization Name:SOUTH REGION HEALTHCARE LLC
Other - Org Name:SOUTH REGION HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANIEZE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-869-2933
Mailing Address - Street 1:405 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-3333
Mailing Address - Country:US
Mailing Address - Phone:832-229-3630
Mailing Address - Fax:832-448-5756
Practice Address - Street 1:1420 GENERAL TAYLOR ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3718
Practice Address - Country:US
Practice Address - Phone:504-895-7755
Practice Address - Fax:504-355-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility