Provider Demographics
NPI:1417779869
Name:SOUTHEASTERN FOUNDATION & CRAWLSPACE REPAIR, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN FOUNDATION & CRAWLSPACE REPAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-669-0117
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-0072
Mailing Address - Country:US
Mailing Address - Phone:803-669-0117
Mailing Address - Fax:
Practice Address - Street 1:100A E DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4430
Practice Address - Country:US
Practice Address - Phone:803-669-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty