Southern Living Services LLC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

2182 Issued in VA

Legal business name

SOUTHERN LIVING SERVICES LLC

Practice address

6688 Tatum Rd
Disputanta, VA 23842-6902

Phone

(804) 550-8674

NPI assigned

Nov 25, 2014

Last updated

Nov 25, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Jayne White, MEMBER

Title

Member

Phone

(804) 550-8674

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1033516703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6688 TATUM RD",
            "city": "DISPUTANTA",
            "state": "VA",
            "postal_code": "238426902",
            "telephone_number": "804-550-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6688 TATUM RD",
            "city": "DISPUTANTA",
            "state": "VA",
            "postal_code": "238426902",
            "telephone_number": "804-550-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN LIVING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-25",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "JAYNE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "804-550-8674",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MEMBER"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "VA",
            "license": "2182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tera N Moore, NP
• More Wellness Medical Clinic LLC
• Shawana Roach
• Tyesha Shaw
• Southern Living Child Care LLC
• Katherine Hall Vickers, O.T.R.
• David White

• Case Manager/Care Coordinator in Disputanta, VA
• Providers in Disputanta, VA by specialty
• Case Manager/Care Coordinator in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.