Healthcare Provider Details

I. General information

NPI: 1588120612
Provider Name (Legal Business Name): SOUTHERN HOME CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E NEZPIQUE ST STE 103
JENNINGS LA
70546-5383
US

IV. Provider business mailing address

805 N WHITTINGOTN PKWY SUITE 400
LOUISVILLE KY
40222
US

V. Phone/Fax

Practice location:
  • Phone: 337-824-2926
  • Fax:
Mailing address:
  • Phone: 502-394-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARGARET SHERRY PEMBERTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-272-3466