NPIMap

Organization Active NPI

Southerncare , Inc.

Doing business as Kindred Hospice

  • Community Based Hospice Care Agency
  • Charlottesville, VA
National Provider Identifier
1467804120
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HSP16221 Issued in VA
Legal business name
SOUTHERNCARE , INC.
Doing business as
Kindred Hospice
Practice address
941 Glenwood Station LN
Unit 204
Charlottesville, VA 22901-5719
Phone
(434) 995-5367
Fax
(434) 995-5367
NPI assigned
Jul 6, 2016
Last updated
Jan 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Authorized official

Name
Jessica Kleberg
Title
VP of Legal Affairs
Phone
(704) 662-0414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HSP16221 VA Primary

Addresses

Primary practice location

941 Glenwood Station LN
Unit 204
Charlottesville, VA 22901-5719

Mailing address

655 Brawley School Rd
Suite 200
Mooresville, NC 28117-9125
Phone (704) 664-2876

Other names 1

  • Kindred Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060622000326 VA Part A Provider - Hospice 8527977735 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Harrisonburg, VA; Charlottesville, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467804120. Details of each certification follow.

Hospice certification: CCN 491590

Legal name
SOUTHERNCARE, INC.
Doing business as
GENTIVA II
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 28, 2007
Last certification
Apr 8, 2016
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 30, 2002 in DE
Enrollment address
420 Neff Ave
Ste 110
Harrisonburg, VA 22801-5435

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Gentiva IICCN 491590 · All quality measures
Ownership
For-Profit
Certified
Feb 28, 2007
Medicare certification status
ActiveFrom the Provider of Services file

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

941 Glenwood Station Ln
Ste 204
Charlottesville, VA 22901
Phone (434) 995-5367

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 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
Curo Health Services Holdings, Inc Organization, Mooresville, NC For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
David Robinson Arnold Individual Corporate OfficerVP and Controller Dec 31, 2021
Operational/Managerial ControlHome Office Administrator Dec 31, 2021
Curo Hospice SC LLC Organization, Mooresville, NC Created for acquisition, 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 For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
Southerncare Holdings, Inc. Organization, Mooresville, NC For-profit 5% Or Greater Direct Ownership Interest Jun 8, 2006 100%
Jessica Harlow Individual W-2 Managing EmployeeAdministrator Jan 19, 2015
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, Atlanta, GA For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 100%
David Allen Causby Individual Corporate OfficerCeo and President Apr 27, 2021
Charlotte Buyer, Inc. Organization, Fort Worth, TX For-profit 5% Or Greater Indirect Ownership Interest Jul 11, 2018 100%
Curo Health Services LLC Organization, Mooresville, NC For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
Janet L Combs Individual Corporate OfficerAssistant Secretary 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 Aug 11, 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 For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%

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

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1467804120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 BRAWLEY SCHOOL RD",
            "address_2": "SUITE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179125",
            "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": "941 GLENWOOD STATION LN",
            "address_2": "UNIT 204",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229015719",
            "telephone_number": "434-995-5367",
            "fax_number": "434-995-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERNCARE , INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "KLEBERG",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "VP OF LEGAL AFFAIRS",
        "authorized_official_telephone_number": "704-662-0414"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "VA",
            "license": "HSP16221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindred Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.