Provider Demographics
NPI:1831136472
Name:SOUTHEASTERN HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN HOME HEALTH CARE, LLC
Other - Org Name:ACCENTCARE HOME HEALTH OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, DEPUTY GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-221-0465
Mailing Address - Street 1:1501 GRUNDY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-1506
Mailing Address - Country:US
Mailing Address - Phone:215-826-0900
Mailing Address - Fax:215-826-8300
Practice Address - Street 1:7502 LEE DAVIS RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3603
Practice Address - Country:US
Practice Address - Phone:804-769-1380
Practice Address - Fax:804-769-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA497508A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010147603Medicaid
VA010252385Medicaid
VA010147646Medicaid
VA010140927Medicaid
VA010147689Medicaid
VA497508AMedicare Oscar/Certification