| Organization Name: | SOUTHERLAND CLARK ENTERPRISES LLC |
| NPI Number: | 1538539093 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLORIOUS SHERMAN JONES (DIRECTOR) |
| Mailing Address: | 315 N. Louisville St. Harlem |
| State: | GA US |
| Postal Code: | 30814 |
| Phone Number: | 7069555558 |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2015 |
| NPI Last Update Date: | 10/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385HR2060X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
| Taxonomy Definition: | A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental retardation and/or developmental disabilities as respite for the regular caregivers. |