Provider Demographics
NPI:1710119912
Name:SOUTHERN COMFORT HOME CARE
Entity Type:Organization
Organization Name:SOUTHERN COMFORT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9197-421-1002
Mailing Address - Street 1:2435 JAY SHAMBLEY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8996
Mailing Address - Country:US
Mailing Address - Phone:919-742-1002
Mailing Address - Fax:
Practice Address - Street 1:2435 JAY SHAMBLEY RD
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8996
Practice Address - Country:US
Practice Address - Phone:919-742-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization