Provider Demographics
NPI:1194358523
Name:SOUTHEAST REHAB LLC
Entity Type:Organization
Organization Name:SOUTHEAST REHAB LLC
Other - Org Name:SOUTHEAST RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WALDROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-665-9950
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-0743
Mailing Address - Country:US
Mailing Address - Phone:318-665-9950
Mailing Address - Fax:318-665-0379
Practice Address - Street 1:608 S HIGHWAY 65 82
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1743
Practice Address - Country:US
Practice Address - Phone:870-265-4333
Practice Address - Fax:318-665-9950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST REHAB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-13
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No283X00000XHospitalsRehabilitation Hospital