=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447666094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EH HOME HEALTH OF THE SOUTHEAST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2014
-----------------------------------------------------
Last Update Date | 12/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 FITZGERALD RD STE 2
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33813-2718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-644-1122
-----------------------------------------------------
Fax | 863-644-1124
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6688 N CENTRAL EXPY SUITE 1300
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-239-6500
-----------------------------------------------------
Fax | 214-239-6581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP OF HOME HEALTH OPERATIONS
-----------------------------------------------------
Name | JULIE DIANE JOLLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-239-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------