SOUTHEAST REHAB LLC NPI 1700959905

NPI Information

  • NPI: 1700959905
  • Provider Name: SOUTHEAST REHAB LLC
  • Classification: Rehabilitation Hospital - 283X00000X
  • Entity Type: Organization
  • :
  • Address: 905 BORGOGNONI DR
    LAKE VILLAGE, AR
    ZIP 71653
  • Phone: (318) 665-9950

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NPI Details

SOUTHEAST REHAB LLC is a rehabilitation hospital in Lake Village, AR. The provider is a hospital or facility that provides health-related, social and/or vocational services to disabled persons to help them attain their maximum functional capacity. SOUTHEAST REHAB LLC NPI is 1700959905. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

905 BORGOGNONI DR
LAKE VILLAGE, AR
ZIP 71653-623
Phone: (318) 665-9950
Fax: (318) 665-0379

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

The enumeration date for this NPI number is 11/16/2006 and was last updated on 11/7/2025.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1283X00000XRehabilitation HospitalAR4376ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1163180526MEDICAIDARKANSAS

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: 11/21/2025

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