| NPI | 1790465342 |
|---|---|
| Former Legal Business Name | SOUTHERN PROFESSIONAL HOME CARE LLC |
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN ELAINE JACKSON Administrator/CEO 864-419-0167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2023-07-19 |