Organization
SOUTHEAST REHAB LLC.
Active
Other names
Southeast Part B Practice
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY WALDROP (ADMINISTRATOR)
(318) 665-9950
Entity
Organization
Contact information
Practice address
903 BORGOGNONI DR, LAKE VILLAGE, AR 71653-1623
(318) 665-9950
Mailing address
903 BORGOGNONI DR, LAKE VILLAGE, AR 71653-1623
(318) 665-9950
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/15/2017
Last updated
06/28/2019
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