Provider Demographics
NPI:1558468769
Name:SOUTHERN HEALTH CARE, INC.
Entity Type:Organization
Organization Name:SOUTHERN HEALTH CARE, INC.
Other - Org Name:THE HERMITAGE RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:EPPS
Authorized Official - Last Name:CLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-875-4551
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-1010
Mailing Address - Country:US
Mailing Address - Phone:910-875-4551
Mailing Address - Fax:
Practice Address - Street 1:139 MALLARD LN
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5203
Practice Address - Country:US
Practice Address - Phone:910-895-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-077-005311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801208Medicaid