Provider Demographics
NPI:1962217901
Name:SOUTHERN GIRL HOMECARE LLC
Entity type:Organization
Organization Name:SOUTHERN GIRL HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-215-1760
Mailing Address - Street 1:3712 OLD MOBILE AVE STE L
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-3767
Mailing Address - Country:US
Mailing Address - Phone:228-215-1760
Mailing Address - Fax:
Practice Address - Street 1:3712 OLD MOBILE AVE STE L
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-3767
Practice Address - Country:US
Practice Address - Phone:228-215-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care