Southern Pines Healthcare LLC
Organization Active NPI Community Based Hospice Care Agency · Benbrook, TX
NPI 1033715248 · NPPES record last updated Jul 16, 2025
Key facts
- NPI
- 1033715248
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- SOUTHERN PINES HEALTHCARE LLC
- Practice address
- 6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918 - Phone
- (832) 553-2276
- NPI assigned
- Dec 11, 2020
- Organization subpart
- No
Authorized official
- Name
- Amber L Tueller
- Title
- Secretary
- Phone
- (208) 207-2726
Owners & managing parties with NPI records 1
-
Charles Shannon Childers, D.O.
Facilities with the same owner 141
Practitioners 1
-
Nehme Alkarra, MD
Affiliated clinicians 3
-
Charles Shannon Childers, D.O.
-
Mark Nicholas Ziats, MD, PHD
Medicare Care Compare: Hospice
- Listed as
- Frontier Hospice
- Ownership
- For-Profit
- Certified
- Apr 8, 2018
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2132498 | Southern Pines Healthcare LLC D/B/a Frontier | Certificate of waiver | Jun 19, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospice certification: CCN 741720
- Legal name
- SOUTHERN PINES HEALTHCARE LLC
- Doing business as
- FRONTIER HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 8, 2018
- Last certification
- Apr 9, 2018
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 6410 Southwest Blvd
Ste 127
Benbrook, TX 76109-6918
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Cornerstone Healthcare Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2021 | 100% |
| Brent Mills |
Corporate Officer |
Mar 26, 2026 | |
| Jonathan Travis Jones |
W-2 Managing Employee |
Dec 14, 2024 | |
| Molly Dame |
W-2 Managing Employee |
Aug 19, 2025 | |
| Charles S Childers |
Contracted Managing Employee |
Dec 3, 2025 | |
| W-2 Managing Employee |
Dec 3, 2025 | ||
| The Pennant Group Inc |
5% Or Greater Indirect Ownership Interest | Jan 1, 2021 | 100% |
| Lisa Flores |
W-2 Managing Employee |
Nov 21, 2025 | |
| Shelton Johnson |
Contracted Managing Employee |
Oct 27, 2025 | |
| W-2 Managing Employee |
Oct 27, 2025 | ||
| John J Gochnour |
Corporate Officer |
Mar 26, 2026 | |
| Amber Tueller |
Corporate Officer |
Apr 10, 2024 | |
| Elliot McMillan |
Corporate Officer |
Apr 10, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210219001045 | TX | Part a Provider - Hospice | 2264847599 | Practice locations: Benbrook, TX |
National Provider Directory
Locations
6410 Southwest Blvd
Ste 127
Benbrook, TX 76109
Phone (817) 847-8888
363 N Sam Houston Pkwy E
Ste 545
Houston, TX 77060
Phone (832) 553-2276
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918
Mailing address
6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918
Phone (832) 553-2276
Other names
- Frontier Hospice
Other providers in Benbrook, TX
- Snoring & Sleep Center Inc
- Lucia Rosario Solano
- Lydia Christine Sommerlad
- Alexandra Sorilla
- Southern Concepts Inc
- Sovereign Case Management LLC
- Laura Katherine Spaulding
- Toni-Ann Cecile Spence
- Joan Littiken Spurlock
- Jahnaya St. Rose
All providers in Benbrook, TX · Community Based Hospice Care Agency in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.