Provider Demographics
NPI:1962734277
Name:SOUTHERN CARE STAFFING LLC
Entity type:Organization
Organization Name:SOUTHERN CARE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-595-6626
Mailing Address - Street 1:1450 N MACK SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3948
Mailing Address - Country:US
Mailing Address - Phone:423-752-5002
Mailing Address - Fax:
Practice Address - Street 1:1450 N MACK SMITH RD
Practice Address - Street 2:SUITE A
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-3948
Practice Address - Country:US
Practice Address - Phone:423-752-5002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN385H00000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherPRIVATE PAY