Provider Demographics
NPI:1588834477
Name:SOUTHERN HOSPITALITY INCORPORATED
Entity Type:Organization
Organization Name:SOUTHERN HOSPITALITY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:ALANE
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-545-3000
Mailing Address - Street 1:2511 E 46TH ST
Mailing Address - Street 2:SUITE J-6
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2460
Mailing Address - Country:US
Mailing Address - Phone:317-545-3000
Mailing Address - Fax:
Practice Address - Street 1:2511 E 46TH ST
Practice Address - Street 2:SUITE J-6
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2460
Practice Address - Country:US
Practice Address - Phone:317-545-3000
Practice Address - Fax:317-545-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health