Healthcare Provider Details

I. General information

NPI: 1790055853
Provider Name (Legal Business Name): SOUTHERN HOME CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 BERNARD DR SUITE 103
ROANOKE VA
24018-4357
US

IV. Provider business mailing address

9901 LINN STATION RD
LOUISVILLE KY
40223-3808
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-0085
  • Fax:
Mailing address:
  • Phone: 502-394-2100
  • Fax: 502-394-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome 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: MS. DEENA G. OMBRES
Title or Position: ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Credential:
Phone: 502-394-2387