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SOUTHEAST REHAB LLC NPI 1194358523


NPI Information

NPI: 1194358523
Provider Name: SOUTHEAST REHAB LLC

Doing Business As: SOUTHEAST RURAL HEALTH CLINIC

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 04D1059020

Address:
608 S HIGHWAY 65 82
LAKE VILLAGE, AR
ZIP 71653
Phone: (870) 265-4333
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SOUTHEAST REHAB LLC is a rural health clinic center in Lake Village, AR. SOUTHEAST REHAB LLC NPI is 1194358523. The provider is registered as an organization entity type.
The provider Is Doing Business As Southeast Rural Health Clinic.

The provider's business location address is:

608 S HIGHWAY 65 82
LAKE VILLAGE, AR
ZIP 71653-743
Phone: (870) 265-4333
Fax: (318) 665-9950

The provider's authorized official is Catherine Martin Waldrop .
The authorized official title is Administrator and has the following contact phone number (318) 665-9950.

The CLIA number assigned to this NPI record is 04D1059020 - hospital with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/13/2020 and was last updated on 3/24/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1283X00000XRehabilitation HospitalNo
2261QR1300XClinic/CenterRural HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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