MEDICARE: SOUTHEAST HOME HEALTH INC

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

General Provider Information

NPI Number	:	1306114855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST HOME HEALTH INC

Provider Business Mailing Address
First Line	:	5008 NW 97TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2455
Country	:	US
Telephone Number	:	954-854-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	5008 NW 97TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2455
Country	:	US
Telephone Number	:	954-854-8205
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH COHN
Credential	:
Telephone Number	:	954-854-8205

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	12/12/2011

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