SOUTHEAST REHAB LLC.


Address: 903 Borgognoni Dr, Lake Village, AR 71653-1623
Phone: 3186659950

SOUTHEAST REHAB LLC. (NPI# 1295276970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1295276970
Entity Type Organization
Organization Name SOUTHEAST REHAB LLC.
Other Organization Name SOUTHEAST PART B PRACTICE
Practice Address 903 Borgognoni Dr
Lake Village
AR 71653-1623
Practice Telephone 3186659950
Mailing Telephone 3186659950
Enumeration Date 2017-03-15
Last Update Date 2019-06-28
Authorized Official Name CATHY WALDROP (ADMINISTRATOR)
Authorized Official Telephone 3186659950
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LG0600X Nurse Practitioner
Specialization: Gerontology
Physician Assistants & Advanced Practice Nursing Providers

Other Provider/Organization Names

Other Name Type Code
Southeast Part B Practice Doing Business As Name - Organization

Office Location

Street Address 903 BORGOGNONI DR
City LAKE VILLAGE
State AR
Zip Code 71653-1623

Providers in the same location

NPI Name Taxonomy Address Enumeration
1700959905 Southeast Rehab LLC Rehabilitation Hospital 903 Borgognoni Dr, Lake Village, AR 71653-1623 2006-11-16
1942658729 Southeast Rehab LLC Physician Assistant 903 Borgognoni Dr, Lake Village, AR 71653-1623 2016-06-02
1700193133 Chicot Snf Operations LLC Skilled Nursing Facility 903 Borgognoni Dr, Lake Village, AR 71653-1623 2010-09-07
1376863597 Chicot Operations, LLC Skilled Nursing Facility 903 Borgognoni Dr, Lake Village, AR 71653-1623 2010-06-10

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1811500192 Ashley Brown Speech-Language Pathologist 336 Us-82, Lake Village, AR 71653 2020-08-26
1861901985 Chicot Memorial Medical Center Clinic/Center 2729 S. Hwy 65 82, Lake Village, AR 71653 2017-09-20
1326586173 Mainline Health Systems, Inc Clinic/Center 360 A Hwy 82, Lake Village, AR 71653 2017-02-01
1508303124 Mainline Health Systems, Inc Clinic/Center 360 A Highway 82, Lake Village, AR 71653 2017-01-20
1689120263 Russell Medical Services Pllc Family Medicine 5071 Highway 82 E, Lake Village, AR 71653 2016-09-01
1528362035 Hillman Chiropractic LLC Chiropractor 2819 Louis Sessions Dr., Lake Village, AR 71653 2010-12-28
1902113913 Sheri K Bagwell Counselor 1127 Second St., Lake Village, AR 71653 2010-09-13
1205154044 Arkansas Department of Health Public Health or Welfare 1742 Hwy 65 and 82 South, Lake Village, AR 71653 2010-05-04
1114259041 William Jackson Weaver General Practice 1754 Lake Hall Road, Lake Village, AR 71653 2010-02-03
1821246992 Maurenella Antionette Nelson Social Worker 1127 Second Street, Lake Village, AR 71653 2008-09-03
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Taxonomy Information

Taxonomy Code 363LG0600X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Gerontology

Taxonomy Definition

Definition to come...

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1881233914 Barbara Faye Ellis Nurse Practitioner 4250 Brewer Rd, Edgemont, AR 72044-9539 2020-01-07
1154964559 Latoya Danielle Young Nurse Practitioner 1413 Sweetgum Ln, North Little Rock, AR 72117-9740 2019-10-18
1932754942 Amy Cooper Nurse Practitioner 14309 Cantrell Rd Ste 7, Little Rock, AR 72223-4230 2019-08-06
1548827066 Melonie Ann Cook Nurse Practitioner 1407 Jennifer St, Springdale, AR 72762-2091 2019-05-20
1659851400 Lorena Aimee Padilla Nurse Practitioner 3003 Napa Ln, Springdale, AR 72764-7818 2018-08-20
1427535673 Michelle D. Joyner Nurse Practitioner 398 Honey Hill Loop, Searcy, AR 72143-9170 2018-07-20
1679012504 Lerizza D Nunag Nurse Practitioner 2540 State Highway 388, Gould, AR 71643-9634 2017-02-13
1407203425 Katherine Antoinette Robertson Nurse Practitioner 1307 Trinity Blvd, Texarkana, AR 71854-8310 2016-05-19
1457716029 Chasta Mandy Barbee-lumpkin Nurse Practitioner 609 Sw 8th St Fl 6, Bentonville, AR 72712-7886 2015-12-23
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Competitor

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City LAKE VILLAGE
Zip Code 71653

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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