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Organization
SOUTHEAST REHAB LLC
Active
Organization
SOUTHEAST REHAB LLC
Active
Other names
Southeast Rehabilitation Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY M WALDROP (CHAIRMAN)
(318) 665-9950
Entity
Organization
Contact information
Practice address
903 BORGOGNONI DR, LAKE VILLAGE, AR 71653-1623
(870) 265-4333
(318) 665-0379
Mailing address
903 BORGOGNONI DR, LAKE VILLAGE, AR 71653-1623
(318) 665-9950
(318) 665-0379
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
06/02/2016
Last updated
06/28/2019
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