Provider Demographics
NPI:1194180539
Name:SOUTHEASTERN COMMUNITY DEVELOPMENT HOME HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:SOUTHEASTERN COMMUNITY DEVELOPMENT HOME HEALTH CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-451-6500
Mailing Address - Street 1:1053 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6749
Mailing Address - Country:US
Mailing Address - Phone:803-451-6500
Mailing Address - Fax:803-454-0371
Practice Address - Street 1:1053 CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6749
Practice Address - Country:US
Practice Address - Phone:803-451-6500
Practice Address - Fax:803-454-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies