Provider Demographics
NPI:1912358110
Name:SOUTHEAST SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHEAST SERVICES, LLC
Other - Org Name:CHOICE CARE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-908-5919
Mailing Address - Street 1:1983 LAKE SHADOW WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4311
Mailing Address - Country:US
Mailing Address - Phone:678-908-5919
Mailing Address - Fax:770-822-2337
Practice Address - Street 1:1983 LAKE SHADOW WAY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4311
Practice Address - Country:US
Practice Address - Phone:678-908-5919
Practice Address - Fax:770-822-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1279251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003171712AMedicaid