Provider Demographics
NPI:1457189433
Name:SOUTHERN LIVING LLC
Entity type:Organization
Organization Name:SOUTHERN LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDAE-ABOAGYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-254-6417
Mailing Address - Street 1:PO BOX 9472
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58106-9472
Mailing Address - Country:US
Mailing Address - Phone:706-254-6417
Mailing Address - Fax:
Practice Address - Street 1:4466 47TH ST S APT 309
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4368
Practice Address - Country:US
Practice Address - Phone:706-254-6417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty