Provider Demographics
NPI:1538361431
Name:SOUTHERN LOVING CARE, INC
Entity type:Organization
Organization Name:SOUTHERN LOVING CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:386-209-1626
Mailing Address - Street 1:106 WHITE AVE SE STE B-2
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-3358
Mailing Address - Country:US
Mailing Address - Phone:386-330-0213
Mailing Address - Fax:386-330-0418
Practice Address - Street 1:106 WHITE AVE SE STE B-2
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3358
Practice Address - Country:US
Practice Address - Phone:386-330-0213
Practice Address - Fax:386-330-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211300305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization