Provider Demographics
NPI:1639316482
Name:SOUTHSIDE CAREGIVERS INC.
Entity Type:Organization
Organization Name:SOUTHSIDE CAREGIVERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:RECREATIONAL THER
Authorized Official - Phone:337-308-1000
Mailing Address - Street 1:1228 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-4028
Mailing Address - Country:US
Mailing Address - Phone:337-594-2090
Mailing Address - Fax:
Practice Address - Street 1:1228 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-4028
Practice Address - Country:US
Practice Address - Phone:337-594-2090
Practice Address - Fax:337-942-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA15152251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based