Provider Demographics
NPI:1184361818
Name:SOUTHERN MADE HOME CARE
Entity type:Organization
Organization Name:SOUTHERN MADE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-490-2986
Mailing Address - Street 1:372 S INDEPENDENCE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1000
Mailing Address - Country:US
Mailing Address - Phone:757-490-2986
Mailing Address - Fax:757-490-5401
Practice Address - Street 1:372 S INDEPENDENCE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1000
Practice Address - Country:US
Practice Address - Phone:757-490-2986
Practice Address - Fax:757-490-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-15
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467927228Medicaid