Provider Demographics
NPI:1780104059
Name:SOUTHERN LIVING ACADEMY PCH INC.
Entity type:Organization
Organization Name:SOUTHERN LIVING ACADEMY PCH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-536-2889
Mailing Address - Street 1:4225 ALTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-2322
Mailing Address - Country:US
Mailing Address - Phone:706-536-2889
Mailing Address - Fax:762-821-2274
Practice Address - Street 1:4225 ALTON STRRET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903
Practice Address - Country:US
Practice Address - Phone:706-536-2889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care