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General NPI Number Information
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NPI Number | 1790192706
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Entity Type | Organization
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Legal Business Name | SOUTHEAST INDUSTRIES, INC
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 1333 LASKIN RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6005
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Country | US
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Telephone | 757-631-7200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 826
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-0826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN FRIEDBERG
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Credential |
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Telephone | 757-631-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 2705122451
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License Number State | VA
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