NPIMap

Organization Active NPI

Southerncare, Inc.

Doing business as SouthernCare Meridian

  • Community Based Hospice Care Agency
  • Meridian, MS
National Provider Identifier
1851339238
Registry record updated May 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
043 Issued in MS
Legal business name
SOUTHERNCARE, INC.
Doing business as
SouthernCare Meridian
Practice address
1406 10TH Ave
Meridian, MS 39301-4413
Phone
(601) 693-0412
Fax
(601) 693-0811
NPI assigned
Jun 4, 2006
Last updated
May 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2016

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) 664-2876

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X
Community Based Hospice Care Agency 251G00000X 043 MS Primary

Addresses

Primary practice location

1406 10TH Ave
Meridian, MS 39301-4413

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
01635559MedicaidMS

Other names 1

  • SouthernCare Meridian Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030528000026 MS Part A Provider - Hospice 8527977735 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Meridian, MS; Newton, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851339238. Details of each certification follow.

Hospice certification: CCN 251541

Legal name
SOUTHERNCARE, INC.
Doing business as
GENTIVA
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 19, 1997
Last certification
Mar 13, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 30, 2002 in DE
Enrollment address
278 Commercial Dr
Newton, MS 39345-9564

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
GentivaCCN 251541 · All quality measures
Ownership
For-Profit
Certified
Jun 19, 1997
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

1406 10th Ave
Meridian, MS 39301
Phone (601) 693-0412

Ownership & related parties

All disclosed owners & managing parties 25

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, Louisville, KY 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 For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
David Robinson Arnold Individual Corporate OfficerVP and Controller Dec 31, 2021
W-2 Managing EmployeeHome Office Administrator 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 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 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, Louisville, KY 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 OfficerChief Executive Officer & 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 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, Louisville, KY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2022 40%
Kah Hospice Company, Inc Organization, Atlanta, GA Corporation 5% Or Greater Indirect Ownership Interest Mar 1, 2022 100%
Morgan Stanley Dean Witter Capital Organization, New York, NY 5% Or Greater Direct Ownership Interest Feb 21, 2003
Hailey Walker Copeland Individual W-2 Managing EmployeeAd; Apr 21, 2024
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%
Andrea M Morgan Individual Contracted Managing EmployeeMD; Apr 1, 2016

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1851339238",
    "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": "1406 10TH AVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014413",
            "telephone_number": "601-693-0412",
            "fax_number": "601-693-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERNCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2016-05-16",
        "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": "704-664-2876"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": "043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01635559",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthernCare Meridian",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.