Provider Demographics
NPI:1982634721
Name:SOUTHEASTERN CHILDREN'S HOME, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN CHILDREN'S HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIMBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-439-0291
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-0337
Mailing Address - Country:US
Mailing Address - Phone:864-439-0259
Mailing Address - Fax:864-949-0248
Practice Address - Street 1:115 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9769
Practice Address - Country:US
Practice Address - Phone:864-493-0259
Practice Address - Fax:864-949-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC896MXHMedicaid