Southern Professional Home Care LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SOUTHERN PROFESSIONAL HOME CARE LLC

Practice address

1200 Woodruff Rd Ste A3
Greenville, SC 29607-5732

Phone

(864) 419-0167

Fax

(864) 213-6317

NPI assigned

Jul 19, 2023

Organization subpart

No

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

Authorized official

Name

Ms. Gwendolyn Elaine Jackson, MA, BSW

Title

Administrator/Ceo

Phone

(864) 419-0167

Specialties & licenses 1

Addresses

Other names 1

• Southern Professional Home Care LLC Former legal business name

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1790465342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 WOODRUFF RD STE A3",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296075732",
            "telephone_number": "864-419-0167",
            "fax_number": "864-213-6317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 WOODRUFF RD STE A3",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296075732",
            "telephone_number": "864-419-0167",
            "fax_number": "864-213-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PROFESSIONAL HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "864-419-0167",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, BSW"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Professional Home Care LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.