Provider Demographics
NPI:1619102407
Name:SOUTHEAST HOMECARE LLC
Entity Type:Organization
Organization Name:SOUTHEAST HOMECARE LLC
Other - Org Name:SOUTHEAST HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-215-4264
Mailing Address - Street 1:1200 NW 17 AVENUE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-819-6400
Mailing Address - Fax:561-819-6401
Practice Address - Street 1:1200 NW 17TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2512
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:2009-05-21
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299992181251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108247OtherMEDICARE PROVIDER NUMBER