Provider Demographics
NPI:1538309513
Name:SOUTHEASTERN UNITED CARE,LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN UNITED CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-9557
Mailing Address - Street 1:P.O. BOX 159
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-0159
Mailing Address - Country:US
Mailing Address - Phone:910-521-9557
Mailing Address - Fax:910-521-0077
Practice Address - Street 1:213 W. CRONLY ST.
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3637
Practice Address - Country:US
Practice Address - Phone:910-276-7635
Practice Address - Fax:910-276-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006402Medicaid