1831136472 NPI number — SOUTHEASTERN HOME HEALTH CARE, LLC

Table of content: (NPI 1831136472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831136472 NPI number — SOUTHEASTERN HOME HEALTH CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN HOME HEALTH CARE, LLC
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:
ACCENTCARE HOME HEALTH OF VIRGINIA
Provider Other Organization Name Type Code:
3
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:
1831136472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 GRUNDY LN
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19007-1506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-826-0900
Provider Business Mailing Address Fax Number:
215-826-8300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7502 LEE DAVIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23111-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-769-1380
Provider Business Practice Location Address Fax Number:
804-769-1377
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SISCEL
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, DEPUTY GENERAL COUNSEL
Authorized Official Telephone Number:
224-221-0465

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  497508A , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010147603 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010252385 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010147646 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010140927 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010147689 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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