Provider Demographics
NPI:1801230586
Name:SOUTH HORIZON HEALTHCARE LLC
Entity Type:Organization
Organization Name:SOUTH HORIZON HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-584-6042
Mailing Address - Street 1:4030 NORTH HENRY BLV.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4030 NORTH HENRY BLV.
Practice Address - Street 2:SUITE 201
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-584-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness