Provider Demographics
NPI:1790875664
Name:SOUTHEAST HOSPITAL
Entity Type:Organization
Organization Name:SOUTHEAST HOSPITAL
Other - Org Name:SOUTHEAST HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME CARE SERVICES ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:573-335-6609
Mailing Address - Street 1:1701 LACEY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5230
Mailing Address - Country:US
Mailing Address - Phone:573-335-6609
Mailing Address - Fax:573-335-5864
Practice Address - Street 1:1701 LACEY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5230
Practice Address - Country:US
Practice Address - Phone:573-335-6609
Practice Address - Fax:573-335-5864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO223-21251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
267121Medicare Oscar/Certification