Provider Demographics
NPI:1073843546
Name:CAROLINA HEALTHCARE SOUTHEAST REGION, LLC
Entity Type:Organization
Organization Name:CAROLINA HEALTHCARE SOUTHEAST REGION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-608-1548
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:SUITE 2501
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3836
Mailing Address - Country:US
Mailing Address - Phone:336-608-1548
Mailing Address - Fax:336-397-0096
Practice Address - Street 1:10612 PROVIDENCE RD STE D-250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0459
Practice Address - Country:US
Practice Address - Phone:336-608-1548
Practice Address - Fax:336-397-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3361251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health