Provider Demographics
NPI:1891823381
Name:SOUTHERN CONCEPTS INC
Entity Type:Organization
Organization Name:SOUTHERN CONCEPTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-299-5161
Mailing Address - Street 1:4800 OVERTON PLZ STE 440
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4435
Mailing Address - Country:US
Mailing Address - Phone:800-299-5161
Mailing Address - Fax:
Practice Address - Street 1:3451 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76116-6330
Practice Address - Country:US
Practice Address - Phone:817-457-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000377901315P00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001007901OtherHCS CONTRACT
TX000738201OtherICF-MR 6TH AND MESQUITE
TX000377901OtherICF-MR 826 N THORP SPRING
TX027764201Medicaid
TX001008032OtherHCS CONTRACT
TX027764201Medicaid
TX000384301OtherICF-MR SOUTHTOWN
TX000377901OtherICF-MR 826 N THORP SPRING
TX000384302OtherICF-MR EASTWOODHAVEN
TX000387501OtherICF-MR TORREY STREET
TX001007901OtherHCS CONTRACT