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General NPI Number Information
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NPI Number | 1942250600
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Entity Type | Organization
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Legal Business Name | SOUTHEAST HEALTH GROUP, INC.
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 2750 N 29TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33020-1521
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Country | US
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Telephone | 954-588-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 N 29TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33020-1521
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Country | US
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Telephone | 954-588-9996
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Fax |
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Authorized Official
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Title or Position | DIR
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Name | ANN STEMBER
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Credential |
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Telephone | 954-588-9996
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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 | 21105096
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License Number State | FL
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