Provider Demographics
NPI:1043757099
Name:SOUTHEAST HOME CARE SERVICES INC
Entity Type:Organization
Organization Name:SOUTHEAST HOME CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:478-297-4755
Mailing Address - Street 1:312 N DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3350
Mailing Address - Country:US
Mailing Address - Phone:478-951-7769
Mailing Address - Fax:855-898-0022
Practice Address - Street 1:312 N DAVIS DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3350
Practice Address - Country:US
Practice Address - Phone:478-951-7769
Practice Address - Fax:855-898-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076-R-119253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA076-R-1119OtherPRIVATE HOME CARE PROVIDER LICENSE/HFR/DCH