Provider Demographics
NPI:1023717964
Name:SOUTHERN HOSPITALTY HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:SOUTHERN HOSPITALTY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-612-7488
Mailing Address - Street 1:102 VIRGINIA CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1458
Mailing Address - Country:US
Mailing Address - Phone:864-612-7488
Mailing Address - Fax:
Practice Address - Street 1:1 CHICK SPRINGS RD # 241I
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4946
Practice Address - Country:US
Practice Address - Phone:864-612-7488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1619629334Medicaid