Provider Demographics
NPI:1588555635
Name:SOUTHEAST REHAB LLC
Entity type:Organization
Organization Name:SOUTHEAST REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:870-265-9810
Mailing Address - Fax:870-265-9813
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:870-265-9810
Practice Address - Fax:870-265-9813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST REHAB LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-15
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center