# SOUTHERN MADE HOME CARE, LLC

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

## Provider details

- **NPI number:** 1467927228
- **Authorized official:** SHAMIRA GAINES (ADMINISTRATIVE DIRECTOR)
- **Authorized official phone:** (703) 490-2273

## Contact information

- **Practice address:** 12531 CLIPPER DR STE 202, WOODBRIDGE, VA 22192-2355
- **Practice address phone:** (703) 490-2273
- **Practice address fax:** (703) 782-1581
- **Mailing address:** 13806 BREEZY RIDGE WAY UNIT 201, WOODBRIDGE, VA 22191-1487
- **Mailing address phone:** (571) 477-4036
- **Mailing address fax:** (703) 782-1581

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 10/09/2018
- **Last updated:** 10/09/2018