Provider Demographics
NPI:1790787042
Name:SOUTHERN HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:SOUTHERN HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-0990
Mailing Address - Street 1:2925 SOUTH CARAWAY ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7313
Mailing Address - Country:US
Mailing Address - Phone:870-932-0990
Mailing Address - Fax:870-932-1124
Practice Address - Street 1:2925 S CARAWAY RD STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-932-0990
Practice Address - Fax:870-932-1124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN HOME HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-01
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150051716Medicaid
AR49852OtherBCBS ORTHOTIC PROVIDER
AR49854OtherBCBS DME PROVIDER
AR4812940001Medicare NSC