Provider Demographics
NPI:1053501056
Name:SOUTHEASTERN HOME HEALTH CARE SERVICES INC
Entity type:Organization
Organization Name:SOUTHEASTERN HOME HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-878-0121
Mailing Address - Street 1:401 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-4807
Mailing Address - Country:US
Mailing Address - Phone:910-878-0121
Mailing Address - Fax:
Practice Address - Street 1:1892 TURNPIKE ROAD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-9998
Practice Address - Country:US
Practice Address - Phone:910-878-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty