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Organization
SOUTHERN COMFORT HEALTH CARE SERVICES LLC
Active
Organization
SOUTHERN COMFORT HEALTH CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY MOANA WILSON JR. BA, MBA (CEO)
(570) 688-8490
Entity
Organization
Contact information
Practice address
2100 N HWY 360 STE 1201, GRAND PRAIRIE, TX 75050-8708
(570) 688-8490
(214) 593-5615
Mailing address
2100 N HWY 360 STE 1201, GRAND PRAIRIE, TX 75050-8708
(570) 688-8490
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
372600000X
Adult Companion
—
NULL
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
—
NULL
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
—
NULL
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
NULL
376J00000X
Homemaker
—
—
Other
Enumeration date
05/09/2022
Last updated
01/29/2026
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