SOUTHEASTERN REGIONAL MEDICAL CENTER (NPI# 1689741589) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689741589 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN REGIONAL MEDICAL CENTER |
| Other Organization Name | WOODHAVEN NURSING & ALZHEIMER'S CARE CENTER-ICF |
| Practice Address |
1150 Pine Run Dr Lumberton NC 28358-2118 |
| Practice Telephone | 9106715703 |
| Mailing Telephone | 9106715703 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. C. THOMAS JOHNSON III (V. P. FINANCE) |
| Authorized Official Telephone | 9106715090 |
| Authorized Official Credential | CPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | H0064 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3416431 | 05 |
| Other Name | Type Code |
|---|---|
| WoodHaven Nursing & Alzheimer's Care Center-ICF | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063779114 | Southeastern Regional Medical Center | Clinic/Center | 2934 N. El M St., Suite B, Lumberton, NC 28358-2981 | 2012-04-13 |
| 1821361346 | Southeastern Regional Medical Center | Pharmacy | 2934 North Elm St, Suite C, Lumberton, NC 28358 | 2012-02-14 |
| 1013245117 | Southeastern Regional Medical Center | Clinic/Center | 1277 Chicken Foot Rd., Hope Mills, NC 28348-7525 | 2009-12-01 |
| 1871735019 | Southeastern Regional Medical Center | Hearing Aid Equipment | 584 Farringdom St, Lumberton, NC 28358-2615 | 2009-04-02 |
| 1780831776 | Southeastern Regional Medical Center | Health Maintenance Organization | 103 W 27th St, Lumberton, NC 28358-3014 | 2008-08-21 |
| 1033396155 | Southeastern Regional Medical Center | Clinic/Center | 9928 N. W.r. Lathan Street, Clarkton, NC 28433 | 2008-01-31 |
| 1932389582 | Southeastern Regional Medical Center | Clinic/Center | 730 Oakridge Blvd Ste A, Lumberton, NC 28358-2324 | 2007-11-13 |
| 1649499278 | Southeastern Regional Medical Center | Substance Abuse Rehabilitation Facility | 107 Dallas Ave, Red Springs, NC 28377-1849 | 2007-04-24 |
| 1215003215 | Southeastern Regional Medical Center | Counselor | 705b Wesley Pines Rd, Lumberton, NC 28358-2105 | 2006-11-28 |
| 1639190242 | Southeastern Regional Medical Center | Clinic/Center | 1100 Pine Run Dr, Lumberton, NC 28358-2118 | 2006-07-21 |
| Street Address |
1150 PINE RUN DR |
| City | LUMBERTON |
| State | NC |
| Zip Code | 28358-2118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528040888 | Southeastern Regional Medical Center | Skilled Nursing Facility | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2005-11-14 |
| 1285245092 | Conrad Kutil Tyrrell | Dietitian, Registered | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2020-08-14 |
| 1538305677 | Southeastern Regional Medical Center | Skilled Nursing Facility | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2008-12-19 |
| 1932171378 | Southeastern Regional Medical Center | Durable Medical Equipment & Medical Supplies | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2006-02-01 |
| 1295706810 | Southeastern Regional Medical Center | Pharmacist | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2006-01-31 |
| 1902877541 | Southeastern Regional Medical Center | Skilled Nursing Facility | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2006-01-31 |
| 1689650681 | Stephen A Martin | Pharmacist | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2005-12-21 |
| 1801872163 | Tina Alexander Bullard | Pharmacist | 1150 Pine Run Dr, Lumberton, NC 28358-2118 | 2005-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649812397 | Monarch | Community/Behavioral Health | 13128 Serenity Street, Huntersville, NC 28358 | 2019-10-15 |
| 1114577194 | Lashonda Patrice Bostic | Social Worker | 4719 Fayetteville Road, Lumberton, NC 28358 | 2019-09-12 |
| 1780232389 | Rosaline Whittington | Technician | 39 Sibley Road, Lumberton, NC 28358 | 2019-08-28 |
| 1790343168 | Emily Graham | Social Worker | 401 S. 27th Street, Lumberton, NC 28358 | 2019-05-31 |
| 1316420722 | Karen Lynn Warwick | Nurse Practitioner | 600 Farringdom St # Ab, Lumberton, NC 28358 | 2018-09-11 |
| 1982184149 | Virginia Feldick Hampton | Speech-Language Pathologist | Coastal Therapy Partners, 210 Liberty Hill Road, Lumberton, NC 28358 | 2018-08-17 |
| 1366941882 | Ashlynn Faircloth Mckeithan | Occupational Therapist | 210 Liberty Hill Road, Lumberton, NC 28358 | 2018-02-10 |
| 1992153506 | Matthew Mercer | Nurse Anesthetist, Certified Registered | 2703 Riverwood Ave, Lumberton, NC 28358 | 2016-05-25 |
| 1295100964 | Chosen Health Care Services Inc | In Home Supportive Care | 705b Wesley Pines Road, Lumberton, NC 28358 | 2015-12-07 |
| 1346626173 | Brittany Renea Chavis | Social Worker | 888 Wire Grass Road, Lumberton, NC 28358 | 2015-08-04 |
| Find all providers in zip 28358 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962686444 | Maple Ltc Group, LLC | Nursing Facility/Intermediate Care Facility | 1170 Linkhaw Rd, Lumberton, NC 28358-2524 | 2007-12-20 |
| 1457548885 | Britthaven, Inc. | Nursing Facility/Intermediate Care Facility | 1170 Linkhaw Rd, Lumberton, NC 28358-2524 | 2007-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841617974 | Christopher Rushmeyer | Nursing Facility/Intermediate Care Facility | 1820 Harris Houston Rd, Unit 621411, Charlotte, NC 28262-9253 | 2014-03-26 |
| 1306284674 | Legacy | Nursing Facility/Intermediate Care Facility | 903 W Main Street, Yadkinville, NC 27055 | 2013-06-10 |
| 1194077024 | Skill Creations | Nursing Facility/Intermediate Care Facility | 2101 Royall Ave, Goldsboro, NC 27534-7408 | 2012-10-02 |
| 1093066375 | Sci-east | Nursing Facility/Intermediate Care Facility | 338 Cooper St, Winterville, NC 28590-9507 | 2012-09-26 |
| 1053662437 | Skill Creations of Clinton | Nursing Facility/Intermediate Care Facility | 223 Forest Trail, Clinton, NC 28328-3353 | 2012-09-26 |
| 1821349101 | Sci-duplin House | Nursing Facility/Intermediate Care Facility | 120 Orville Street, Warsaw, NC 28398-2221 | 2012-09-26 |
| 1801147186 | Skill Creations of Kenansville | Nursing Facility/Intermediate Care Facility | 218 S Stokes Street, Kenansville, NC 28349-0001 | 2012-09-26 |
| 1750632030 | Sci-coastal House I and II | Nursing Facility/Intermediate Care Facility | 1974 W Lakeshore Drive, Wilmington, NC 28401-6856 | 2012-09-26 |
| 1760732994 | Sci-triangle House II | Nursing Facility/Intermediate Care Facility | 1523 Tyonek Dr, Durham, NC 27703-5639 | 2012-09-14 |
| 1275883498 | Skill Creations of Kinston | Nursing Facility/Intermediate Care Facility | 901 Doctors Dr, Kinston, NC 28501-1574 | 2012-09-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.