Organization
SOUTHERNCARE, INC.
Active
Other names
SouthernCare Green Bay
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA KLEBERG (VP OF LEGAL AFFAIRS)
(704) 664-2876
Entity
Organization
Contact information
Practice address
1800 W MASON ST STE A, GREEN BAY, WI 54303-2333
(920) 496-1690
(920) 496-1693
Mailing address
655 BRAWLEY SCHOOL RD, SUITE 200, MOORESVILLE, NC 28117-9125
(704) 664-2876
(704) 664-1306
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
2016
WI
251G00000X
Community Based Hospice Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016
STATE LICENSE NUMBER
WI
05
—
43191100
—
WI
Enumeration date
06/06/2006
Last updated
11/13/2017
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