Provider Demographics
NPI:1740569920
Name:SOUTHEAST HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHEAST HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BULIT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:954-894-0633
Mailing Address - Street 1:5100 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6538
Mailing Address - Country:US
Mailing Address - Phone:954-894-0633
Mailing Address - Fax:
Practice Address - Street 1:5100 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6538
Practice Address - Country:US
Practice Address - Phone:954-894-0633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center