MEDICARE: SOUTHEAST HOMECARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HHA299991990	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	108138	OTHER	FL	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1003041823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST HOMECARE LLC

Provider Business Mailing Address
First Line	:	3125 W. COMMERCIAL BLVD.
Second Line	:	SUITE 110
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33309
Country	:	US
Telephone Number	:	954-615-6200
Fax Number	:	954-615-6202

Provider Business Practice Location Address
First Line	:	3125 W COMMERCIAL BLVD
Second Line	:	SUITE 110
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3448
Country	:	US
Telephone Number	:	954-615-6200
Fax Number	:	954-615-6202

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	LINDA MENDEZ
Credential	:
Telephone Number	:	844-215-4264

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	09/18/2019

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Directions to “SOUTHEAST HOMECARE LLC ” Practice Location

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