Provider Demographics
NPI:1497111751
Name:SOUTHEASTERN HOME HEALTH CARE GROUP
Entity Type:Organization
Organization Name:SOUTHEASTERN HOME HEALTH CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-284-0731
Mailing Address - Street 1:122 WAVERLY WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8835
Mailing Address - Country:US
Mailing Address - Phone:910-284-0731
Mailing Address - Fax:
Practice Address - Street 1:122 WAVERLY WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-8835
Practice Address - Country:US
Practice Address - Phone:910-284-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies