Provider Demographics
NPI:1497456610
Name:SOUTHERN WELLS HEALTH CARE, LLC.
Entity Type:Organization
Organization Name:SOUTHERN WELLS HEALTH CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAC
Authorized Official - Middle Name:E
Authorized Official - Last Name:AMOKWAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-253-6050
Mailing Address - Street 1:6718 86TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4775
Mailing Address - Country:US
Mailing Address - Phone:774-253-6050
Mailing Address - Fax:
Practice Address - Street 1:6718 86TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4775
Practice Address - Country:US
Practice Address - Phone:774-253-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty