Provider Demographics
NPI:1821214891
Name:SOUTHERNCARE, INC
Entity Type:Organization
Organization Name:SOUTHERNCARE, INC
Other - Org Name:SOUTHERNCARE SAN ANGELO
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 1:4114 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5614
Practice Address - Country:US
Practice Address - Phone:325-949-2900
Practice Address - Fax:325-949-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based