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NPI Code Detail

MEDICARE: SOUTHERN HOME CARE SERVICES, INC.

MEDICARE: SOUTHERN HOME CARE SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1538671896
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN HOME CARE SERVICES, INC.
Provider Business Mailing Address
First Line : 805 N WHITTINGTON PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-7101
Country : US
Telephone Number : 502-394-2100
Fax Number :
Provider Business Practice Location Address
First Line : 5512 BIG TYLER RD
Second Line :
City : CROSS LANES
State : WV
Zip : 25313-1304
Country : US
Telephone Number : 304-766-9830
Fax Number :
Authorized Official
Title or Position : PROVIDER ENROLLMENT
Name : TIMOTHY WHOBREY
Credential :
Telephone Number : 502-630-7249
Provider Enumeration Date : 10/26/2017
Last Update Date : 10/19/2021

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Directions to “SOUTHERN HOME CARE SERVICES, INC. ” Practice Location

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