NPIMap

Organization Active NPI

Southerncare, Inc.

Doing business as SouthernCare Youngstown

  • Community Based Hospice Care Agency
  • Youngstown, OH
National Provider Identifier
1104864198
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0140HSP Issued in OH
Legal business name
SOUTHERNCARE, INC.
Doing business as
SouthernCare Youngstown
Practice address
970 Windham CT Ste 9
Youngstown, OH 44512-5082
Phone
(330) 797-8940
Fax
(330) 797-8943
NPI assigned
Jun 3, 2006
Last updated
Jun 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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

Authorized official

Name
Jennifer Tyler
Title
VP Regulatory Counsel
Phone
(678) 449-0459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0140HSP OH Primary

Addresses

Primary practice location

970 Windham CT Ste 9
Youngstown, OH 44512-5082

Mailing address

PO Box 4060
Attn Regulatory
Mooresville, NC 28117-4060
Phone (046) 642-8767

Other practice location 1

9501 US Highway 250 N Ste 2
Milan, OH 44846-9377
Phone (567) 401-0200

Other practice location 2

2300 W 4th St Ste 100
Ontario, OH 44906-1205
Phone (419) 774-0555

Other practice location 3

3570 Executive Dr Ste 112
Uniontown, OH 44685-8712
Phone (330) 920-1909

Other practice location 4

100 Welday Ave Ste G
Wintersville, OH 43953-3779
Phone (740) 217-2420

Other practice location 5

6545 W Central Ave Ste 103
Toledo, OH 43617-1034
Phone (419) 843-6106

Other identifiers 1

IdentifierTypeStateIssuer
2507264MedicaidOH

Other names 1

  • SouthernCare Youngstown Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031211000150 OH Part A Provider - Hospice 8527977735 Practice locations: Ontario, OH; Toledo, OH; Uniontown, OH; Wintersville, OH; Youngstown, OH; Milan, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104864198. Details of each certification follow.

Hospice certification: CCN 361617

Legal name
SOUTHERNCARE, INC.
Doing business as
SOUTHERNCARE YOUNGSTOWN
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 31, 2004
Last certification
Oct 25, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 30, 2002 in DE
Enrollment address
970 Windham CT
Ste 9
Youngstown, OH 44512-5082

Care Compare: Hospice

Medicare Care Compare
Listed as
Southern Care YoungstownCCN 361617 · All quality measures
Ownership
For-Profit
Certified
Mar 31, 2004
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
36D1075654Southerncare, Inc970 Windham Court Suite 9, Youngstown, OH 44512Certificate of waiverOct 24, 2027

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%
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 OfficerEvp and General Counsel Apr 27, 2021
Corporate DirectorBoard Member 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 and Treasurer Dec 31, 2021
OtherVP and Treasurer Dec 31, 2021
Curo Hospice SC LLC Organization, Mooresville, NC LLC, For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
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 Jun 6, 2014 100%
Amanda Starcher Individual W-2 Managing EmployeeAdministrator Aug 1, 2021
Southerncare Holdings, Inc. Organization, Mooresville, NC Corporation, For-profit 5% Or Greater Direct Ownership Interest Jun 6, 2014 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 Dec 22, 2022 40%
Bruce Daniel Willner Individual Contracted Managing EmployeeMD; May 25, 2016
Humana Inc Organization, Louisville, KY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Falcon Hospice, LP Organization, Atlanta, GA For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
David Allen Causby Individual Corporate OfficerChief Executive Officer Apr 27, 2021
Corporate DirectorBoard Member Apr 27, 2021
Charlotte Buyer, Inc. Organization, Fort Worth, TX 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, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
Janet L Combs Individual Corporate OfficerVP Licensure, Authorized Official 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 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 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1104864198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4060",
            "address_2": "ATTN REGULATORY",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281174060",
            "telephone_number": "046-642-8767",
            "fax_number": "704-664-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 WINDHAM CT STE 9",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445125082",
            "telephone_number": "330-797-8940",
            "fax_number": "330-797-8943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9501 US Highway 250 N Ste 2",
            "address_purpose": "LOCATION",
            "city": "Milan",
            "state": "OH",
            "postal_code": "448469377",
            "country_code": "US",
            "telephone_number": "567-401-0200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2300 W 4th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "OH",
            "postal_code": "449061205",
            "country_code": "US",
            "telephone_number": "419-774-0555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3570 Executive Dr Ste 112",
            "address_purpose": "LOCATION",
            "city": "Uniontown",
            "state": "OH",
            "postal_code": "446858712",
            "country_code": "US",
            "telephone_number": "330-920-1909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Welday Ave Ste G",
            "address_purpose": "LOCATION",
            "city": "Wintersville",
            "state": "OH",
            "postal_code": "439533779",
            "country_code": "US",
            "telephone_number": "740-217-2420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6545 W Central Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436171034",
            "country_code": "US",
            "telephone_number": "419-843-6106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERNCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "VP REGULATORY COUNSEL",
        "authorized_official_telephone_number": "678-449-0459"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OH",
            "license": "0140HSP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2507264",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthernCare Youngstown",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SouthernCare Youngstown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.