Provider Demographics
NPI:1659819134
Name:SOUTHERN CARE CONNECTION, LLC
Entity Type:Organization
Organization Name:SOUTHERN CARE CONNECTION, LLC
Other - Org Name:#1 IN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-341-9290
Mailing Address - Street 1:4512 BURKE DR
Mailing Address - Street 2:
Mailing Address - City:MATAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003
Mailing Address - Country:US
Mailing Address - Phone:504-341-9290
Mailing Address - Fax:504-341-3605
Practice Address - Street 1:1539 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130
Practice Address - Country:US
Practice Address - Phone:504-341-9290
Practice Address - Fax:504-341-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1813567Medicaid
LA1820997Medicaid