Southeast Rehab LLC
Clinic/Center, Rural Health in Lake Village, AR. Organization (NPI-2).
NPI number1194358523
StatusActive
Last updated in NPPESMar 24, 2023
Details
- NPI
- 1194358523
- Entity type
- Organization (NPI-2)
- Legal business name
- Southeast Rehab LLC
- Organization subpart
- Yes
- Enumeration date
- Feb 13, 2020
- Certification date
- Mar 24, 2023
- Last updated
- Mar 24, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
| 283X00000X | Rehabilitation Hospital | – | – |
Other names
- Southeast Rural Health Clinic (Doing Business As)
Practice location
608 S Highway 65 82Lake Village, AR 71653-1743
Phone 870-265-4333 · Fax 318-665-9950
Mailing address
Po Box 743Lake Village, AR 71653-0743
Phone 318-665-9950 · Fax 318-665-0379
Authorized official
Catherine Martin Waldrop
Administrator
3186659950
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