MEDICARE: SOUTHEAST ALABAMA 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518102938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST ALABAMA HOMECARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:	SUITE A
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	804 GLOVER AVE
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2018
Country	:	US
Telephone Number	:	334-347-4800
Fax Number	:	334-347-4827

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MR. NICHOLAS GACHASSIN III
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	12/01/2020

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