Provider Demographics
NPI:1760622609
Name:SOUTHERN HEALTH AND WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHERN HEALTH AND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-396-1357
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-0247
Mailing Address - Country:US
Mailing Address - Phone:252-398-4089
Mailing Address - Fax:252-398-3318
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1417
Practice Address - Country:US
Practice Address - Phone:252-398-4089
Practice Address - Fax:252-398-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1700949559Medicaid