Provider Demographics
NPI:1407810450
Name:SOUTHAST HOMECARE CORP
Entity Type:Organization
Organization Name:SOUTHAST HOMECARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:BHSA
Authorized Official - Phone:954-615-6200
Mailing Address - Street 1:3355 NW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6306
Mailing Address - Country:US
Mailing Address - Phone:954-615-6200
Mailing Address - Fax:954-615-6202
Practice Address - Street 1:3355 NW 55TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6306
Practice Address - Country:US
Practice Address - Phone:954-615-6200
Practice Address - Fax:954-615-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108138Medicare ID - Type Unspecified