Provider Demographics
NPI:1992198246
Name:SOUTHERN HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHERN HOME CARE SERVICES, INC.
Other - Org Name:ALL WAYS CARING HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7425
Mailing Address - Street 1:9901 LINN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3808
Mailing Address - Country:US
Mailing Address - Phone:502-394-2100
Mailing Address - Fax:
Practice Address - Street 1:455 SAINT ANDREWS RD
Practice Address - Street 2:BUILDING A, SUITE 1
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4486
Practice Address - Country:US
Practice Address - Phone:803-772-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care