# SOUTHERN PROFESSIONAL HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Professional Home Care LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790465342
- **Authorized official:** MS. GWENDOLYN ELAINE JACKSON MA, BSW (ADMINISTRATOR/CEO)
- **Authorized official phone:** (864) 419-0167

## Contact information

- **Practice address:** 1200 WOODRUFF RD STE A3, GREENVILLE, SC 29607-5732
- **Practice address phone:** (864) 419-0167
- **Practice address fax:** (864) 213-6317
- **Mailing address:** 1200 WOODRUFF RD STE A3, GREENVILLE, SC 29607-5732
- **Mailing address phone:** (864) 419-0167
- **Mailing address fax:** (864) 213-6317

## Taxonomy

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

## Other

- **Enumeration date:** 07/19/2023
- **Last updated:** 07/19/2023