Provider Demographics
NPI:1851338339
Name:SOUTHERNCARE INC
Entity Type:Organization
Organization Name:SOUTHERNCARE INC
Other - Org Name:SOUTHERNCARE NEWTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REGULATORY & LICENSING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-662-0416
Mailing Address - Street 1:3536 VANN ROAD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-655-4809
Mailing Address - Fax:205-655-0587
Practice Address - Street 1:278 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-9564
Practice Address - Country:US
Practice Address - Phone:601-683-7500
Practice Address - Fax:601-683-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS043163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01635559Medicaid
MS01635559Medicaid