MEDICARE: SOUTHERNCARE, 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
1	251G00000X	Community Based Hospice Care Agency	383513	MI
2	251G00000X	Community Based Hospice Care Agency	1041000079	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093753188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERNCARE, INC.

Provider Business Mailing Address
First Line	:	655 BRAWLEY SCHOOL RD
Second Line	:	SUITE 200
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9125
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:	704-664-1306

Provider Business Practice Location Address
First Line	:	1965 BOARDMAN RD
Second Line	:	SUITE B
City	:	JACKSON
State	:	MI
Zip	:	49202-1979
Country	:	US
Telephone Number	:	517-788-6838
Fax Number	:	517-788-6839

Authorized Official
Title or Position	:	VP OF LICENSURE
Name	:	JANET COMBS
Credential	:
Telephone Number	:	704-662-1761

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	04/07/2026

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Directions to “SOUTHERNCARE, INC. ” Practice Location

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