# SOUTHERN HOSPITALITY AT HOME, INC.

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

## Provider details

- **NPI number:** 1497443782
- **Authorized official:** MRS. KIERRA BACON (CEO/OWNER)
- **Authorized official phone:** (478) 295-0946

## Contact information

- **Practice address:** 511 N COBB ST STE 4, MILLEDGEVILLE, GA 31061-3278
- **Practice address phone:** (478) 295-0946
- **Practice address fax:** (478) 295-0434
- **Mailing address:** 4786 HIGH OAK DR, MACON, GA 31210-5647
- **Mailing address phone:** (912) 314-3811
- **Mailing address fax:** (478) 259-3820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 374U00000X | Home Health Aide | — | NULL | — |
| 374U00000X | Home Health Aide | — | — | — |

## Other

- **Enumeration date:** 04/26/2023
- **Last updated:** 09/08/2024