SOUTHERN SENIOR LIVING NPI 1740592773

NPI Information

NPI: 1740592773
Provider Name: SOUTHERN SENIOR LIVING
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
215 SELLERS ST
DOUGLAS, GA
ZIP 31533
Phone: (912) 383-9883
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SOUTHERN SENIOR LIVING is an assisted living facility in Douglas, GA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. SOUTHERN SENIOR LIVING NPI is 1740592773. The provider is registered as an organization entity type.

The provider's business location address is:

215 SELLERS ST
DOUGLAS, GA
ZIP 31533-609
Phone: (912) 383-9883
Fax: (912) 383-8571

The provider's authorized official is Beth M. Harper .
The authorized official title is Ceo/adminstrator and has the following contact phone number (912) 383-9883.

The enumeration date for this NPI number is 7/7/2010 and was last updated on 7/7/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		034-01-011-1	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	390875605A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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