NPIMap

Organization Active NPI

Southerncare, Inc.

Doing business as Heartland

  • Community Based Hospice Care Agency
  • Fairview Heights, IL
National Provider Identifier
1154020659
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SOUTHERNCARE, INC.
Doing business as
Heartland
Practice address
333 Salem PL Ste 165
Fairview Heights, IL 62208-1341
Phone
(618) 632-0304
NPI assigned
Feb 23, 2023
Last updated
Feb 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

333 Salem PL Ste 165
Fairview Heights, IL 62208-1341

Mailing address

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

Other names 1

  • Heartland Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231219004075 IL Part A Provider - Hospice 8527977735 Practice locations: Fairview Heights, IL; Springfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154020659. Details of each certification follow.

Hospice certification: CCN 141636

Legal name
SOUTHERNCARE, INC.
Doing business as
HEARTLAND HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 2, 2011
Last certification
Nov 21, 2019
Ownership / control type
Proprietary - Corporation
Most recent change of ownership
Nov 1, 2023
Organization structure
CorporationProprietary
Enrollment address
333 Salem PL
Ste 165
Fairview Heights, IL 62208-1341

Care Compare: Hospice

Medicare Care Compare
Listed as
Heartland Hospice (Fairview Heights)CCN 141636 · All quality measures
Ownership
For-Profit
Certified
May 2, 2011
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
14D2008238Heartland Hospice (Fairview Heights)333 Salem Place, Ste 165, Fairview Heights, IL 62208Certificate of waiverJun 7, 2028

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.

Ownership & related parties

All disclosed owners & managing parties 23

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, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%
Kentucky Homecare Parent Inc. Organization, Atlanta, GA Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Ronald C Lazas Individual Corporate OfficerEvp, Secretary & General Counsel Apr 27, 2021
Corporate DirectorBoard Member Apr 27, 2021
Curo Health Services Holdings, Inc Organization, Mooresville, NC Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
David Robinson Arnold Individual Corporate OfficerVP, Treasurer & Controller Dec 31, 2021
Operational/Managerial ControlChain Home Office Administrator Dec 31, 2021
Curo Hospice SC LLC Organization, Mooresville, NC LLC, Holding company, 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, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 1, 2011 100%
Southerncare Holdings, Inc. Organization, Mooresville, NC Corporation, Holding company, For-profit 5% Or Greater Direct Ownership Interest Dec 30, 2002 100%
Charlotte Midco, LLC Organization, Atlanta, GA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
Kentucky Homecare Holdings, Inc. Organization, Atlanta, GA Corporation, Holding company, 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, Atlanta, GA Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
David Allen Causby Individual Corporate OfficerPresident & Ceo Apr 27, 2021
Corporate DirectorBoard Member Apr 27, 2021
Charlotte Buyer, Inc. Organization, Mooresville, NC Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jul 11, 2018 100%
Curo Health Services LLC Organization, Mooresville, NC LLC, For-profit 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 Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 60%
Centerwell Health Services Inc Organization, Louisville, KY Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 22, 2022 40%
Kah Hospice Company, Inc Organization, Atlanta, GA Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
CH Services Group Holdings Inc Organization, Mooresville, NC Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%
CH Services Holdings Inc Organization, Mooresville, NC Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%
Ronald Page Belongy Individual W-2 Managing EmployeeAdministrator Mar 19, 2012

Owners & managing parties with NPI records 18

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

View all 18

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

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2023 Change of OwnershipThis provider was the buyer Promedica Hospice (Fairview Heights)CCN 141636, IL, NPI 1700105152

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1154020659",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 SALEM PL STE 165",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622081341",
            "telephone_number": "618-632-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERNCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "COMBS",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VP OF LICENSURE",
        "authorized_official_telephone_number": "704-664-2876"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairview Heights, IL

Sources for this page

Verify at the official NPI Registry.