Provider Demographics
NPI:1497443782
Name:SOUTHERN HOSPITALITY AT HOME, INC.
Entity Type:Organization
Organization Name:SOUTHERN HOSPITALITY AT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-200-6399
Mailing Address - Street 1:4786 HIGH OAK DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5647
Mailing Address - Country:US
Mailing Address - Phone:912-314-3811
Mailing Address - Fax:478-259-3820
Practice Address - Street 1:4786 HIGH OAK DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5647
Practice Address - Country:US
Practice Address - Phone:912-314-3811
Practice Address - Fax:478-259-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty