Provider Demographics
NPI:1033359567
Name:SOUTHEASTERN UNITED CARE,LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN UNITED CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-9557
Mailing Address - Street 1:P.O. BOX 159
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-0159
Mailing Address - Country:US
Mailing Address - Phone:910-521-9557
Mailing Address - Fax:910-521-0077
Practice Address - Street 1:30 DRAKE'S BRANCH DRIVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7325
Practice Address - Country:US
Practice Address - Phone:910-521-9557
Practice Address - Fax:910-521-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2923251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408256Medicaid