Provider Demographics
NPI:1619978053
Name:SOUTHEASTERN HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN HEALTH CARE CENTER, INC.
Other - Org Name:BARNESVILLE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:740-425-3648
Mailing Address - Street 1:400 CARRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-1317
Mailing Address - Country:US
Mailing Address - Phone:740-425-3648
Mailing Address - Fax:740-425-4075
Practice Address - Street 1:400 CARRIE AVE
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1317
Practice Address - Country:US
Practice Address - Phone:740-425-3648
Practice Address - Fax:740-425-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2978314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0416697Medicaid
OH0416697Medicaid