Organization
SOUTHERN HOSPITALITY HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA MOORE (OWNER)
(601) 513-0359
Entity
Organization
Contact information
Practice address
84 COUNTY ROAD 3771, HEIDELBERG, MS 39439-5016
(601) 513-0359
Mailing address
84 COUNTY ROAD 3771, HEIDELBERG, MS 39439-5016
(601) 513-0359
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45244386
VETERAN AFFAIRS
MS
Enumeration date
03/06/2014
Last updated
03/06/2014
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