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	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1376841338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7101
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	9696 BONITA BEACH RD SE
Second Line	:	SUITE 206
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-8502
Country	:	US
Telephone Number	:	239-936-8292
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	MR. TIMOTHY WHOBREY
Credential	:
Telephone Number	:	502-630-7249

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	09/02/2021

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