Provider Demographics
NPI:1043564024
Name:SOUTHEASTERN COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SOUTHEASTERN COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:DEBBIE
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-272-9129
Mailing Address - Street 1:11276 US HWY 301 NORTH
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-3789
Mailing Address - Country:US
Mailing Address - Phone:910-272-9129
Mailing Address - Fax:910-272-9141
Practice Address - Street 1:11276 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-3789
Practice Address - Country:US
Practice Address - Phone:910-272-9129
Practice Address - Fax:910-272-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty