Organization
SANDRA GANT
Active
Other names
Southern Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF D GANT (PRESIDENT)
(662) 647-0093
Entity
Organization
Contact information
Practice address
8865 FIRST INDUSTRIAL DR, SOUTHAVEN, MS 38671-1919
(662) 342-8527
(662) 280-3708
Mailing address
8865 FIRST INDUSTRIAL DR, SOUTHAVEN, MS 38671-1919
(662) 342-8527
(662) 280-3708
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
068039932
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00045117
—
MS
Enumeration date
04/09/2007
Last updated
09/04/2008
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