Healthcare Provider Details

I. General information

NPI: 1124703988
Provider Name (Legal Business Name): SOUTHEASTERN RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 LEE ANN DR
CONCORD NC
28025-9504
US

IV. Provider business mailing address

1018 LEE ANN DR NE
CONCORD NC
28025-2911
US

V. Phone/Fax

Practice location:
  • Phone: 404-771-9863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMISON HOFFMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 404-771-9863