Provider Demographics
NPI:1023292778
Name:SOUTHEASTERN UNITED CARE LLC
Entity type:Organization
Organization Name:SOUTHEASTERN UNITED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:910-521-9557
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-0159
Mailing Address - Country:US
Mailing Address - Phone:910-521-9557
Mailing Address - Fax:910-521-0077
Practice Address - Street 1:213 W CRONLY ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3637
Practice Address - Country:US
Practice Address - Phone:910-276-7635
Practice Address - Fax:910-276-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3129251E00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302154BMedicaid
NC8302154GMedicaid
NC8302154Medicaid
NC8302154HMedicaid
NC6006402Medicaid