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General NPI Number Information
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NPI Number | 1649499278
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 DALLAS AVE
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City | RED SPRINGS
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State | NC
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Zip | 28377-1849
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Country | US
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Telephone | 910-272-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 705- B WESLEY PINE ROAD
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City | LUMBERTON
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State | NC
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Zip | 28358
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Country | US
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Telephone | 910-272-3030
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES LARRY PITTMAN
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Credential | MA,LCAS,CCS
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Telephone | 910-272-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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