NPIMap

Organization Active NPI

Southerncare, Inc.

Doing business as Gentiva II

  • Community Based Hospice Care Agency
  • Meadville, PA
National Provider Identifier
1093741282
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
16811601 Issued in PA
Legal business name
SOUTHERNCARE, INC.
Doing business as
Gentiva II
Practice address
1119 Park Ave Ste 7
Meadville, PA 16335-3107
Phone
(814) 336-4660
Fax
(814) 336-3378
NPI assigned
Jun 23, 2006
Last updated
Jan 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Janet Combs
Title
VP of Licensure
Phone
(704) 664-2876

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X PA
Community Based Hospice Care Agency 251G00000X 16811601 PA Primary

Addresses

Primary practice location

1119 Park Ave Ste 7
Meadville, PA 16335-3107

Mailing address

PO Box 4060
Mooresville, NC 28117-4060
Phone (704) 664-2876

Other identifiers 3

IdentifierTypeStateIssuer
00890434000MedicaidPA
1008904340007MedicaidPA
16811601OtherPASTATE LICENSE NUMBER

Other names 1

  • Gentiva II Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060710000328 PA Part A Provider - Hospice 8527977735 Practice locations: Meadville, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093741282. Details of each certification follow.

Hospice certification: CCN 391681

Legal name
SOUTHERNCARE, INC.
Doing business as
GENTIVA II
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 28, 2006
Last certification
Aug 8, 2015
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 30, 2002 in DE
Enrollment address
1119 Park Ave
Ste 7
Meadville, PA 16335-3107

Care Compare: Hospice

Medicare Care Compare
Listed as
Gentiva IICCN 391681 · All quality measures
Ownership
For-Profit
Certified
Nov 28, 2006
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2051245Southerncare, Inc - D/B/a Gentiva II1119 Park Avenue, Ste 7, Meadville, PA 16335Certificate of waiverDec 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Southerncare Inc43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1119 Park Ave
Ste 107
Meadville, PA 16335

1245 Park Ave
Meadville, PA 16335
Phone (814) 336-4660

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
CH Services Midco Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%
Dean Spencer Individual Contracted Managing Employee Jul 10, 2016
Kentucky Homecare Parent Inc. Organization, Atlanta, GA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Ronald C Lazas Individual Corporate OfficerExecutive VP and General Counsel Apr 27, 2021
Curo Health Services Holdings, Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
David Robinson Arnold Individual Corporate OfficerVP, Treasurer & Controller Dec 31, 2021
Curo Hospice SC LLC Organization, Mooresville, NC Created for acquisition, LLC, For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
Anne Schobey Individual W-2 Managing EmployeeAd; Jan 15, 2024
Thomas Joseph Dolan Individual Corporate OfficerChief Financial Officer Nov 30, 2021
Ksoc Holdings, Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Dec 1, 2011 100%
Southerncare Holdings, Inc. Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Direct Ownership Interest Jun 23, 2006 100%
Charlotte Midco, LLC Organization, Atlanta, GA LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
Kentucky Homecare Holdings, Inc. Organization, Atlanta, GA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Humana Inc Organization, Louisville, KY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Falcon Hospice, LP Organization, Mooresville, NC For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
David Allen Causby Individual Corporate OfficerChief Executive Officer / President Apr 27, 2021
Charlotte Buyer, Inc. Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jul 11, 2018 100%
Curo Health Services LLC Organization, Mooresville, NC LLC, For-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
Janet L Combs Individual Corporate OfficerVP of Licensure Nov 1, 2021
CD&R Falcon Holdings, LP Organization, New York, NY For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 60%
Centerwell Health Services Inc Organization, Atlanta, GA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Dec 22, 2022 40%
Kah Hospice Company, Inc Organization, Atlanta, GA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
CH Services Group Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%
CH Services Holdings Inc Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%

Owners & managing parties with NPI records 19

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 19

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gentiva IICincinnati, OH, CCN 361704 Hospice 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017

Facilities with the same owner 195

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 195

Practitioners & affiliated clinicians

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1093741282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4060",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281174060",
            "telephone_number": "704-664-2876",
            "fax_number": "704-664-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 PARK AVE STE 7",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353107",
            "telephone_number": "814-336-4660",
            "fax_number": "814-336-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERNCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "COMBS",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "VP OF LICENSURE",
        "authorized_official_telephone_number": "704-664-2876",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "PA",
            "license": "16811601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00890434000",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008904340007",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "16811601",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentiva II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meadville, PA

Sources for this page

Verify at the official NPI Registry.