Provider Demographics
NPI:1942250600
Name:SOUTHEAST HEALTH GROUP, INC.
Entity Type:Organization
Organization Name:SOUTHEAST HEALTH GROUP, INC.
Other - Org Name:AMERICAN HEALTH SERVICES OF BROWARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-588-9996
Mailing Address - Street 1:2750 N 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-1521
Mailing Address - Country:US
Mailing Address - Phone:954-588-9996
Mailing Address - Fax:
Practice Address - Street 1:2750 N 29TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1521
Practice Address - Country:US
Practice Address - Phone:954-588-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21105096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107425Medicare Oscar/Certification