Provider Demographics
NPI:1851586028
Name:SOUTHERN CRESCENT CARE,LLC
Entity Type:Organization
Organization Name:SOUTHERN CRESCENT CARE,LLC
Other - Org Name:HOME HELPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CNA
Authorized Official - Phone:678-565-8700
Mailing Address - Street 1:135 EAGLES WALK
Mailing Address - Street 2:SUITE 325 A
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7206
Mailing Address - Country:US
Mailing Address - Phone:678-565-8700
Mailing Address - Fax:678-565-8775
Practice Address - Street 1:135 EAGLES WALK
Practice Address - Street 2:SUITE 325 A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7206
Practice Address - Country:US
Practice Address - Phone:678-565-8700
Practice Address - Fax:678-565-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-0012251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health