Provider Demographics
NPI:1952545055
Name:SOUTHEASTERN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN HEALTHCARE, LLC
Other - Org Name:BRIGHTSTAR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-206-1167
Mailing Address - Street 1:161A JOHN JEFFERSON RD.
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5640
Mailing Address - Country:US
Mailing Address - Phone:757-206-1167
Mailing Address - Fax:757-208-0639
Practice Address - Street 1:161A JOHN JEFFERSON RD.
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5640
Practice Address - Country:US
Practice Address - Phone:757-206-1167
Practice Address - Fax:757-208-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09566251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care