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General NPI Number Information
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NPI Number | 1972947000
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Entity Type | Organization
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Legal Business Name | SOUTHEAST ASSOCIATES LLC
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 2612 HARWOOD ROAD STE B
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City | BEDFORD
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State | TX
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Zip | 76021
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Country | US
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Telephone | 817-868-7100
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Fax | 817-868-7102
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Provider Business Mailing Address
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Address Line | 2612 HARWOOD RD STE B
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City | BEDFORD
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State | TX
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Zip | 76021-8308
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Country | US
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Telephone | 817-868-7100
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Fax | 817-868-7102
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Authorized Official
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Title or Position | OWNER
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Name | ROKAN UDDIN
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Credential |
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Telephone | 972-802-3191
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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 | 011775
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License Number State | TX
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