Provider Demographics
NPI:1013013523
Name:SOUTHEASTERN REGIONAL MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHEASTERN REGIONAL MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PREVATTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-272-1238
Mailing Address - Street 1:450 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-9494
Mailing Address - Country:US
Mailing Address - Phone:910-738-5261
Mailing Address - Fax:910-738-8230
Practice Address - Street 1:300 W 27TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3075
Practice Address - Country:US
Practice Address - Phone:910-272-1230
Practice Address - Fax:910-738-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891122KMedicaid
NC891370NMedicaid
NC8961588Medicaid
NC89132HOMedicaid
NC5902916Medicaid
NC8912834Medicaid
NC5901420Medicaid
NC891141QMedicaid
NC8912273Medicaid
NC89133RKMedicaid
2283702Medicare ID - Type UnspecifiedHOSSEINI
NC89133RKMedicaid
2255633Medicare ID - Type UnspecifiedPURDY
2050713Medicare ID - Type UnspecifiedDONIPARTHI
NC8961588Medicaid
NC891141QMedicaid
NC891122KMedicaid
0169Medicare ID - Type UnspecifiedINPATIENT DR GP
2025614Medicare ID - Type UnspecifiedMERCHANT
NC5901420Medicaid