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	:	1720624216
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	:	40222-5186
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 N PATTERSON ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2511
Country	:	US
Telephone Number	:	229-244-8854
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	STEVEN REED
Credential	:
Telephone Number	:	502-630-7438

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	11/20/2019

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