Healthcare Provider Details

I. General information

NPI: 1336290147
Provider Name (Legal Business Name): SOUTHEASTERN HEALTHCARE OF NORTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CARL SANDBURG CT
RALEIGH NC
27610-2049
US

IV. Provider business mailing address

PO BOX 14144
RALEIGH NC
27620-4144
US

V. Phone/Fax

Practice location:
  • Phone: 919-212-8580
  • Fax: 919-212-8581
Mailing address:
  • Phone: 919-212-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-092-746
License Number StateNC

VIII. Authorized Official

Name: EVELYN SANDERS
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 919-987-2791