Southaven Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

033614 Issued in MO

Legal business name

SOUTHAVEN INC

Practice address

612 South by-Pass
Kennett, MO 63857

Phone

(573) 888-9213

Fax

(573) 888-9218

NPI assigned

Mar 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Gina Dawn Stoverink

Title

Owner Administrator

Phone

(573) 888-9213

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1013034602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 SOUTH BY-PASS",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "63857",
            "telephone_number": "573-888-9213",
            "fax_number": "573-888-9218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 SOUTH BY-PASS",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "63857",
            "telephone_number": "573-888-9213",
            "fax_number": "573-888-9218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHAVEN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "STOVERINK",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER ADMINISTRATOR",
        "authorized_official_telephone_number": "573-888-9213",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "033614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266179704",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie A Smith, M.D.
• Valerie Marie Smith
• Eric Snipes, LPC
• Wuthisak Soonattrakul
• Soporex DME, Inc.
• Southeast Missouri Health Network
• Southeast Missouri Health Network
• Southern Emergency Services I PLC
• Southern Emergency Services PLLC
• Loren Sowell

• Assisted Living Facility in Kennett, MO
• Providers in Kennett, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.