Provider Demographics
NPI:1366817496
Name:SOUTHCARE SPECIALTY SERVICES, LLC
Entity type:Organization
Organization Name:SOUTHCARE SPECIALTY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-873-2273
Mailing Address - Street 1:222 DONNELL BLVD.
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322
Mailing Address - Country:US
Mailing Address - Phone:334-873-2273
Mailing Address - Fax:334-873-2165
Practice Address - Street 1:222 DONNELL BLVD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2107
Practice Address - Country:US
Practice Address - Phone:334-873-2273
Practice Address - Fax:334-873-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health