Provider Demographics
NPI:1619766292
Name:SOUTHERN CHARM SENIOR LIVING LLC
Entity type:Organization
Organization Name:SOUTHERN CHARM SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDWORK
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:501-672-6405
Mailing Address - Street 1:7103 SAMPLES RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8348
Mailing Address - Country:US
Mailing Address - Phone:501-672-6405
Mailing Address - Fax:501-367-7707
Practice Address - Street 1:7103 SAMPLES RD STE 1
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-8348
Practice Address - Country:US
Practice Address - Phone:501-672-6405
Practice Address - Fax:501-367-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home