Healthcare Provider Details

I. General information

NPI: 1295321818
Provider Name (Legal Business Name): SOUTHERN HOME CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 OREGON AVE
GREENWOOD SC
29646-2273
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-7101
US

V. Phone/Fax

Practice location:
  • Phone: 803-336-1062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

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