Southern Homecare, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

010908 Issued in TX

Legal business name

SOUTHERN HOMECARE, INC

Practice address

11500 Pellicano Dr
Unit B10
El Paso, TX 79936

Phone

(915) 857-8573

Fax

(915) 591-3932

NPI assigned

Sep 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ismael Salcido, LVN

Title

Ceo, Alternate Administrator

Phone

(915) 857-8573

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Home health agency certification: CCN 679725

Legal name

SOUTHERN HOMECARE INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Feb 14, 2008

Last certification

Nov 15, 2019

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Jul 21, 2006 in TX

Enrollment address

11500 Pellicano Dr
Unit B10
El Paso, TX 79936

Listed as

Southern Homecare IncCCN 679725

Ownership

Proprietary

Certified

Feb 14, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1174625644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 PELLICANO DR",
            "address_2": "UNIT B10",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79936",
            "telephone_number": "915-857-8573",
            "fax_number": "915-591-3932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 PELLICANO DR",
            "address_2": "UNIT B10",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79936",
            "telephone_number": "915-857-8573",
            "fax_number": "915-591-3932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HOMECARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-03",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "SALCIDO",
        "authorized_official_first_name": "ISMAEL",
        "authorized_official_title_or_position": "CEO, ALTERNATE ADMINISTRATOR",
        "authorized_official_telephone_number": "915-857-8573",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "010908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.