Provider Demographics
NPI:1780825042
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:
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:PO 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 1:306 BEAMAN ST.
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2908
Practice Address - Country:US
Practice Address - Phone:910-521-9557
Practice Address - Fax:910-521-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006398Medicaid