# SOUTHERN HOME ASSISTED LIVING,INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174691646
- **Authorized official:** MRS. KAREN CECILE STOE RN (PRESIDENT)
- **Authorized official phone:** (850) 263-7999

## Contact information

- **Practice address:** 3854 HIGHWAY 2, GRACEVILLE, FL 32440-7406
- **Practice address phone:** (850) 263-7999
- **Practice address fax:** (850) 263-6555
- **Mailing address:** 3854 HWY 2, GRACEVILLE, FL 32440
- **Mailing address phone:** (850) 263-7999
- **Mailing address fax:** (850) 263-6555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 372600000X | Adult Companion | AL10417 | FL | Yes |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 08/22/2020