Provider Demographics
NPI:1447236575
Name:SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Entity Type:Organization
Organization Name:SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Other - Org Name:SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REGIONAL OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-778-0020
Mailing Address - Street 1:208 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1768
Mailing Address - Country:US
Mailing Address - Phone:573-996-2141
Mailing Address - Fax:573-996-4151
Practice Address - Street 1:208 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1768
Practice Address - Country:US
Practice Address - Phone:573-996-2141
Practice Address - Fax:573-996-4151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-20
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO851-HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI133OtherBLUE CROSS
MI580634509Medicaid
MI580634509Medicaid