NPIMap

Organization Active NPI

Southerncare, Inc

Doing business as Kindred Hospice - Vicksburg

  • Community Based Hospice Care Agency
  • Vicksburg, MS
National Provider Identifier
1952581803
Registry record updated Mar 25, 2019
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
Kindred Hospice - Vicksburg
Practice address
1990 S Frontage Rd Ste I
Vicksburg, MS 39180-5232
Phone
(601) 924-8285
Fax
(601) 924-8788
NPI assigned
Nov 8, 2007
Last updated
Mar 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Authorized official

Name
Jessica Kleberg
Title
SVP of Legal and Compliance
Phone
(704) 664-2876

Specialties & licenses 1

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

Addresses

Primary practice location

1990 S Frontage Rd Ste I
Vicksburg, MS 39180-5232

Mailing address

655 Brawley School Rd Ste 200
Mooresville, NC 28117-9601
Phone (704) 664-2876

Other identifiers 1

IdentifierTypeStateIssuer
00770385MedicaidMS

Other names 1

  • Kindred Hospice - Vicksburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060807000111 MS Part A Provider - Hospice 8527977735 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vicksburg, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952581803. Details of each certification follow.

Hospice certification: CCN 251559

Legal name
SOUTHERNCARE, INC.
Doing business as
GENTIVA
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 14, 2000
Last certification
Mar 30, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 30, 2002 in DE
Enrollment address
1990 S Frontage Rd
Ste 1
Vicksburg, MS 39180-5232

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
GentivaCCN 251559 · All quality measures
Ownership
For-Profit
Certified
Mar 14, 2000
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1990 S Frontage Rd
Ste I
Vicksburg, MS 39180
Phone (601) 924-8285

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
Ksoc Holdings, Inc. Organization, Mooresville, NC For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
CH Services Midco Holdings Inc Organization, Mooresville, NC For-profit 5% Or Greater Indirect Ownership Interest Feb 5, 2015 100%
Laurie Shannon Devine Individual W-2 Managing EmployeeAdministrator Aug 28, 2022
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 OfficerExecutive VP & 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 For-profit 5% Or Greater Indirect Ownership Interest Jun 6, 2014 100%
Thomas Joseph Dolan Individual Corporate OfficerChief Financial Officer Nov 30, 2021
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, 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 OfficerChief Executive Officer & President Apr 27, 2021
Charlotte Buyer, Inc. Organization, Mooresville, NC Corporation, 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 5% Or Greater Indirect Ownership Interest Aug 11, 2022 60%
Centerwell Health Services Inc Organization, Atlanta, GA Corporation, Holding company, 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
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 2

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": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553472000000",
    "number": "1952581803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 BRAWLEY SCHOOL RD STE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179601",
            "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": "1990 S FRONTAGE RD STE I",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805232",
            "telephone_number": "601-924-8285",
            "fax_number": "601-924-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERNCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2019-03-25",
        "status": "A",
        "authorized_official_last_name": "KLEBERG",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "SVP OF LEGAL AND COMPLIANCE",
        "authorized_official_telephone_number": "704-664-2876"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770385",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindred Hospice - Vicksburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vicksburg, MS

Sources for this page

Verify at the official NPI Registry.