Provider Demographics
NPI:1578587317
Name:SOUTHERN HOME RESPIRATORY OF FL
Entity Type:Organization
Organization Name:SOUTHERN HOME RESPIRATORY OF FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER SECRETARY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-263-3800
Mailing Address - Street 1:5426 CLIFFF ST
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-1734
Mailing Address - Country:US
Mailing Address - Phone:850-263-3800
Mailing Address - Fax:850-263-5600
Practice Address - Street 1:5426 CLIFFF ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1734
Practice Address - Country:US
Practice Address - Phone:850-263-3800
Practice Address - Fax:850-263-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312609332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9765OtherBCBS
FLR9765OtherBCBS