1043564024 NPI number — SOUTHEASTERN COMMUNITY SERVICES

Table of content: (NPI 1043564024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043564024 NPI number — SOUTHEASTERN COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN COMMUNITY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043564024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11276 US HWY 301 NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28360-3789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-272-9129
Provider Business Mailing Address Fax Number:
910-272-9141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11276 US HIGHWAY 301 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28360-3789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-272-9129
Provider Business Practice Location Address Fax Number:
910-272-9141
Provider Enumeration Date:
10/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HARDIN
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
DEBBIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-272-9129

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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