Southern Made Home Care, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SOUTHERN MADE HOME CARE, LLC

Practice address

12531 Clipper Dr Ste 202
Woodbridge, VA 22192-2355

Phone

(703) 490-2273

Fax

(703) 782-1581

NPI assigned

Oct 9, 2018

Organization subpart

No

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

Authorized official

Name

Shamira Gaines

Title

Administrative Director

Phone

(703) 490-2273

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539043200000",
    "number": "1467927228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13806 BREEZY RIDGE WAY UNIT 201",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221911487",
            "telephone_number": "571-477-4036",
            "fax_number": "703-782-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12531 CLIPPER DR STE 202",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922355",
            "telephone_number": "703-490-2273",
            "fax_number": "703-782-1581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MADE HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-09",
        "last_updated": "2018-10-09",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "SHAMIRA",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "703-490-2273"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Home Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; 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.