Provider Demographics
NPI:1053497404
Name:COMFORCARE SENIOR SERVICES
Entity Type:Organization
Organization Name:COMFORCARE SENIOR SERVICES
Other - Org Name:SOUTHEASTERN HOME HEALTH CARE SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:910-272-0121
Mailing Address - Street 1:405 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-7913
Mailing Address - Country:US
Mailing Address - Phone:910-272-0121
Mailing Address - Fax:910-272-0141
Practice Address - Street 1:2003 N PINE ST STE B
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3935
Practice Address - Country:US
Practice Address - Phone:910-272-0121
Practice Address - Fax:910-272-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NCHC33423747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418102Medicaid
NC6601465Medicaid
NC8301840GMedicaid
NC8301840BMedicaid
NC8301840Medicaid