Provider Demographics
NPI:1356962443
Name:SOUTHERN HOSPITALITY ADULT DAY HEALTH AGENCY LLC
Entity type:Organization
Organization Name:SOUTHERN HOSPITALITY ADULT DAY HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-682-5291
Mailing Address - Street 1:3349 NORTHSIDE DR W
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2178
Mailing Address - Country:US
Mailing Address - Phone:912-687-9235
Mailing Address - Fax:912-259-9455
Practice Address - Street 1:3349 NORTHSIDE DR W
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2178
Practice Address - Country:US
Practice Address - Phone:912-687-9235
Practice Address - Fax:912-259-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care