Provider Demographics
NPI:1740518919
Name:SOUTHERN HOSPITALITY HOME HEALTH CARE, INCORPORATED
Entity type:Organization
Organization Name:SOUTHERN HOSPITALITY HOME HEALTH CARE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANSELM 'AC'
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:RCP, RRT,
Authorized Official - Phone:972-222-9067
Mailing Address - Street 1:1708 TIGRIS TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1572
Mailing Address - Country:US
Mailing Address - Phone:972-222-9067
Mailing Address - Fax:972-584-1708
Practice Address - Street 1:1708 TIGRIS TRL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1572
Practice Address - Country:US
Practice Address - Phone:972-222-9067
Practice Address - Fax:972-584-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health