Provider Demographics
NPI:1598223141
Name:SOUTHERN NURSES INC.
Entity Type:Organization
Organization Name:SOUTHERN NURSES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ST. JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:409-460-0603
Mailing Address - Street 1:13054 US HIGHWAY 96 S
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75956-4549
Mailing Address - Country:US
Mailing Address - Phone:409-460-0603
Mailing Address - Fax:
Practice Address - Street 1:254 PARKSIDE LOOP
Practice Address - Street 2:
Practice Address - City:BROOKELAND
Practice Address - State:TX
Practice Address - Zip Code:75931-6247
Practice Address - Country:US
Practice Address - Phone:409-698-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility