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	315P00000X	Intellectual Disabilities Intermediate Care Facility
2	372500000X	Chore Provider
3	3747P1801X	Personal Care Attendant
4	3747A0650X	Attendant Care Provider
5	372600000X	Adult Companion
6	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1770410151
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 E MCNEESE ST STE A
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-4754
Country	:	US
Telephone Number	:	337-458-1045
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR PROVIDER ENROLLMENT
Name	:	ANGIE MATTINGLY
Credential	:
Telephone Number	:	502-394-2100

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/19/2026

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