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General NPI Number Information
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NPI Number | 1003041823
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Entity Type | Organization
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Legal Business Name | SOUTHEAST HOMECARE LLC
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 3125 W COMMERCIAL BLVD SUITE 110
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3448
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Country | US
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Telephone | 954-615-6200
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Fax | 954-615-6202
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Provider Business Mailing Address
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Address Line | 3125 W. COMMERCIAL BLVD. SUITE 110
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City | FT. LAUDERDALE
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State | FL
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Zip | 33309
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Country | US
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Telephone | 954-615-6200
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Fax | 954-615-6202
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | LINDA MENDEZ
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Credential |
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Telephone | 844-215-4264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA299991990
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License Number State | FL
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