Provider Demographics
NPI:1457305971
Name:SOUTHERN QUALITY HOME HEALTH CARE
Entity Type:Organization
Organization Name:SOUTHERN QUALITY HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TERHUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-364-8014
Mailing Address - Street 1:2701 MANHATTTAN BLVD.
Mailing Address - Street 2:SUITE #18
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-364-8014
Mailing Address - Fax:504-364-8054
Practice Address - Street 1:2701 MANHATTTAN BLVD.
Practice Address - Street 2:SUITE #18
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-364-8014
Practice Address - Fax:504-364-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA486251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1403661Medicaid
LA191199OtherCOVENTRY PRIVATE INS.
LA197485Medicare ID - Type Unspecified