Provider Demographics
NPI:1306888151
Name:SOUTHEASTERN HEALTH OF PENNSYLVANIA, INC
Entity type:Organization
Organization Name:SOUTHEASTERN HEALTH OF PENNSYLVANIA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:215-788-3900
Mailing Address - Street 1:101 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-5301
Mailing Address - Country:US
Mailing Address - Phone:610-269-9876
Mailing Address - Fax:610-269-9566
Practice Address - Street 1:101 PLAZA DR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-5301
Practice Address - Country:US
Practice Address - Phone:610-269-9876
Practice Address - Fax:610-269-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA747205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011101600002Medicaid