Provider Demographics
NPI:1518901610
Name:SOUTHEASTERN HEALTH SERVICES OF PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN HEALTH SERVICES OF PENNSYLVANIA, LLC
Other - Org Name:ACCENTCARE HEALTH OF PENNSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAMMARUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-826-0900
Mailing Address - Street 1:1501 GRUNDY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-1506
Mailing Address - Country:US
Mailing Address - Phone:215-826-0900
Mailing Address - Fax:215-826-8300
Practice Address - Street 1:1501 GRUNDY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-1506
Practice Address - Country:US
Practice Address - Phone:215-826-0900
Practice Address - Fax:215-826-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA747205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011101600003Medicaid
PA39-7472Medicare ID - Type UnspecifiedMEDICARE NUMBER