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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1699036384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	9901 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3808
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 10TH AVE N
Second Line	:	SUITE 203-W
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6606
Country	:	US
Telephone Number	:	561-742-4913
Fax Number	:

Authorized Official
Title or Position	:	PRIVACY OFFICER
Name	:	DEENA OMBRES
Credential	:
Telephone Number	:	502-394-2387

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/30/2012

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