Southeastern Healthcare of North Carolina, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MHL-092-746 Issued in NC

Legal business name

SOUTHEASTERN HEALTHCARE OF NORTH CAROLINA, INC.

Practice address

3401 Carl Sandburg CT
Raleigh, NC 27610-2049

Phone

(919) 212-8580

Fax

(919) 212-8581

NPI assigned

Jan 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Evelyn Sanders, LCSW

Title

Executive Director

Phone

(919) 987-2791

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1336290147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14144",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276204144",
            "telephone_number": "919-212-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CARL SANDBURG CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276102049",
            "telephone_number": "919-212-8580",
            "fax_number": "919-212-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN HEALTHCARE OF NORTH CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-987-2791",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL-092-746",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8303214",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Family Services, LLC
• Southeast Primary Care, PLLC
• Southeastern Adult Day Center
• Southeastern Adult Day Center
• Southeastern Adult Day Center
• Southeastern Imaging Consultants, LLC
• Southeastern Orthopedics Sports Medicine & Shoulder Center PA
• Southeastern Residential Services of NC
• Southeastern Wake Adult Day Center
• Southeastern Wake Adult Day Center

• Community/Behavioral Health Agency in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.