Provider Demographics
NPI:1396985669
Name:SOUTHERN COMFORT FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:SOUTHERN COMFORT FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DELILAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-687-3222
Mailing Address - Street 1:58725 BELLEVIEW DR
Mailing Address - Street 2:STE. A-7
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3948
Mailing Address - Country:US
Mailing Address - Phone:225-687-3222
Mailing Address - Fax:225-687-3277
Practice Address - Street 1:58725 BELLEVIEW DR
Practice Address - Street 2:STE. A-7
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3948
Practice Address - Country:US
Practice Address - Phone:225-687-3222
Practice Address - Fax:225-687-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 15185305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization