Provider Demographics
NPI:1689890642
Name:SOUTHERNCARE, INC
Entity Type:Organization
Organization Name:SOUTHERNCARE, INC
Other - Org Name:SOUTHERNCARE CEDAR RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-655-4809
Mailing Address - Street 1:3536 VANN RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3221
Mailing Address - Country:US
Mailing Address - Phone:205-655-4809
Mailing Address - Fax:205-655-0587
Practice Address - Street 1:5005 BOWLING ST SW
Practice Address - Street 2:STE 3
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5070
Practice Address - Country:US
Practice Address - Phone:319-364-2204
Practice Address - Fax:319-364-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based