Provider Demographics
NPI:1528011491
Name:SOUTHEAST HOMECARE CORPORATOIN
Entity Type:Organization
Organization Name:SOUTHEAST HOMECARE CORPORATOIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-507-2400
Mailing Address - Street 1:1200 NW 17TH AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2503
Mailing Address - Country:US
Mailing Address - Phone:561-819-6400
Mailing Address - Fax:561-819-6401
Practice Address - Street 1:1200 NW 17TH AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2503
Practice Address - Country:US
Practice Address - Phone:561-819-6400
Practice Address - Fax:561-819-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
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
FL108247Medicare ID - Type Unspecified