Healthcare Provider Details

I. General information

NPI: 1255521159
Provider Name (Legal Business Name): SOUTHEASTERN HOME HEALTH CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 TURNPIKE ROAD
RAEFORD NC
28376-9998
US

IV. Provider business mailing address

401 E 11TH ST
LUMBERTON NC
28358-4807
US

V. Phone/Fax

Practice location:
  • Phone: 910-878-0121
  • Fax:
Mailing address:
  • Phone: 910-878-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DIANE SURGEON
Title or Position: PRESIDENT
Credential:
Phone: 910-878-0121