Provider Demographics
NPI:1407178874
Name:SOUTHERN ASSURED HOME HEALTH, LLC
Entity Type:Organization
Organization Name:SOUTHERN ASSURED HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:361-649-4192
Mailing Address - Street 1:9330 CORPORATE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1251
Mailing Address - Country:US
Mailing Address - Phone:210-257-5765
Mailing Address - Fax:210-257-0419
Practice Address - Street 1:9330 CORPORATE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1251
Practice Address - Country:US
Practice Address - Phone:210-257-5765
Practice Address - Fax:210-257-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012878251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012878OtherDEPARTMENT OF AGING AND DISABILITY SERVICES
TX012878OtherDEPARTMENT OF AGING AND DISABILITY SERVICES