Provider Demographics
NPI:1780367649
Name:SOUTHEASTERN HEALTH CARE GROUP LLC
Entity type:Organization
Organization Name:SOUTHEASTERN HEALTH CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILHELMENIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-521-8157
Mailing Address - Street 1:6727 WINGARD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1741
Mailing Address - Country:US
Mailing Address - Phone:803-521-8157
Mailing Address - Fax:
Practice Address - Street 1:6727 WINGARD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1741
Practice Address - Country:US
Practice Address - Phone:803-521-8157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies