MEDICARE: SOUTHERN HOME CARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	251E00000X	Home Health Agency
3	253Z00000X	In Home Supportive Care Agency

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

General Provider Information

NPI Number	:	1134411671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY STE 400
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7102
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 BROOKS ST STE B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-8249
Country	:	US
Telephone Number	:	406-251-9333
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MARGARET S PEMBERTON
Credential	:
Telephone Number	:	502-394-2100

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	03/18/2026

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