Provider Demographics
NPI:1841730181
Name:SOUTHERN CARE CONNECTION, LLC
Entity type:Organization
Organization Name:SOUTHERN CARE CONNECTION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-652-1847
Mailing Address - Street 1:4512 BURKE DR.
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003
Mailing Address - Country:US
Mailing Address - Phone:985-652-1847
Mailing Address - Fax:985-652-1897
Practice Address - Street 1:1101 W AIRLINE HWY, SUITE J
Practice Address - Street 2:
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-652-1847
Practice Address - Fax:985-652-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1821063Medicaid
LA1813532Medicaid