# SOUTHEAST REHAB LLC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeast Part B Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295276970
- **Authorized official:** CATHY WALDROP (ADMINISTRATOR)
- **Authorized official phone:** (318) 665-9950

## Contact information

- **Practice address:** 903 BORGOGNONI DR, LAKE VILLAGE, AR 71653-1623
- **Practice address phone:** (318) 665-9950
- **Mailing address:** 903 BORGOGNONI DR, LAKE VILLAGE, AR 71653-1623
- **Mailing address phone:** (318) 665-9950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2017
- **Last updated:** 06/28/2019