Healthcare Provider Details

I. General information

NPI: 1679401269
Provider Name (Legal Business Name): SOUTHERN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 N SCOTTSDALE RD
SCOTTSDALE AZ
85253-4405
US

IV. Provider business mailing address

6710 N SCOTTSDALE RD
SCOTTSDALE AZ
85253-4405
US

V. Phone/Fax

Practice location:
  • Phone: 217-799-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTEN BOUGARD
Title or Position: OWNER
Credential:
Phone: 217-799-7353