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General NPI Number Information
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NPI Number | 1952545055
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN HEALTHCARE, LLC
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 04/21/2009
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Provider Practice Location Address
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Address Line | 161A JOHN JEFFERSON RD.
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5640
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Country | US
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Telephone | 757-206-1167
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Fax | 757-208-0639
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Provider Business Mailing Address
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Address Line | 161A JOHN JEFFERSON RD.
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5640
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Country | US
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Telephone | 757-206-1167
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Fax | 757-208-0639
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. ROBERT KOHAN
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Credential |
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Telephone | 757-206-1167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HCO-09566
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-09566
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License Number State | VA
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