Provider Demographics
NPI:1124259965
Name:SOUTHERN HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:SOUTHERN HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:S
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-249-0660
Mailing Address - Street 1:633 NE 167TH ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2442
Mailing Address - Country:US
Mailing Address - Phone:305-249-0660
Mailing Address - Fax:305-249-0650
Practice Address - Street 1:633 NE 167TH ST
Practice Address - Street 2:SUITE 602
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2442
Practice Address - Country:US
Practice Address - Phone:305-249-0660
Practice Address - Fax:305-249-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL228561253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682363796OtherMEDICAID DEVELOPMENTAL DISABILITY WAIVER
FL683012900OtherMEDICAID AGED AND DISABLED ADULT WAIVER
FL682363703OtherMEDICAID FAMILIAL DYSAUTONOMIA WAIVER
FL682363798OtherMEDICAID FSL WAIVER
FL682028000OtherMEDICAID PROJECT AIDS CARE WAIVER