Provider Demographics
NPI:1396590071
Name:SOUTHERN OAKS HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:SOUTHERN OAKS HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AVISHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SYAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-210-8793
Mailing Address - Street 1:5815 LIVE OAK PARKWAY D
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5815 LIVE OAK PARKWAY D
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:470-210-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health