Provider Demographics
NPI:1881874733
Name:SOUTHERNCARE, INC
Entity type:Organization
Organization Name:SOUTHERNCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-655-4809
Mailing Address - Street 1:3536 VANN RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3221
Mailing Address - Country:US
Mailing Address - Phone:205-655-4809
Mailing Address - Fax:205-655-0587
Practice Address - Street 1:20 ARENA WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7064
Practice Address - Country:US
Practice Address - Phone:205-655-4809
Practice Address - Fax:205-655-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based