SOUTHEAST REHAB LLC (NPI# 1942658729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942658729 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST REHAB LLC |
| Other Organization Name | SOUTHEAST REHABILITATION HOSPITAL |
| Practice Address |
903 Borgognoni Dr Lake Village AR 71653-1623 |
| Practice Telephone | 8702654333 |
| Practice Fax Number | 3186650379 |
| Mailing Telephone | 3186659950 |
| Mailing Fax Number | 3186650379 |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2019-06-28 |
| Authorized Official Name | CATHY M WALDROP (CHAIRMAN) |
| Authorized Official Telephone | 3186659950 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Southeast Rehabilitation Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629307137 | Southeast Rehab LLC | Clinic/Center | 2555 Meridian Blvd, Ste. 330, Franklin, TN 37067-6363 | 2009-12-11 |
| 1700959905 | Southeast Rehab LLC | Rehabilitation Hospital | 903 Borgognoni Dr, Lake Village, AR 71653-1623 | 2006-11-16 |
| 1194358523 | Southeast Rehab LLC | Rehabilitation Hospital | 608 S Highway 65 82, Lake Village, AR 71653-1743 | 2020-02-13 |
| Street Address |
903 BORGOGNONI DR |
| City | LAKE VILLAGE |
| State | AR |
| Zip Code | 71653-1623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700959905 | Southeast Rehab LLC | Rehabilitation Hospital | 903 Borgognoni Dr, Lake Village, AR 71653-1623 | 2006-11-16 |
| 1295276970 | Southeast Rehab LLC. | Nurse Practitioner | 903 Borgognoni Dr, Lake Village, AR 71653-1623 | 2017-03-15 |
| 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 |
| 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 |
| Find all providers in zip 71653 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063042893 | Kidneysue, LLC | Family Medicine | 216 Summit Ridge Pl, Hot Springs, AR 71901-8671 | 2020-01-21 |
| 1619470275 | Haley Walters | Family Medicine | 210 S Thompson St Ste 5, Springdale, AR 72764-4261 | 2018-03-09 |
| 1811426232 | Netscript Telemedicine Solutions | Family Medicine | 235 Cr 3520, Clarksville, AR 72830 | 2017-06-08 |
| 1730532003 | Healthstar Physicians of Hot Springs, Pllc | Family Medicine | 120 Adcock Road, Suite D, Hot Springs, AR 71913-7958 | 2016-07-21 |
| 1649556150 | Joseph Edward Hughes | Family Medicine | 1009 Rossland Dr, Jonesboro, AR 72404-8471 | 2011-10-28 |
| 1104105972 | Shipley & Sills Family Practice, Pllc | Family Medicine | 4003 Massard Rd., Fort Smith, AR 72903 | 2011-08-11 |
| 1649417361 | Gerald Lawrence Guyer | Family Medicine | 2915 Ashley Dr, Conway, AR 72034-7336 | 2009-01-16 |
| 1578759965 | Timothy Ewing Bainum | Family Medicine | 2673 Highway 70 E, Glenwood, AR 71943-8750 | 2007-09-19 |
| 1356563241 | Gil Johnson | Family Medicine | 2511 A College Ave, Conway, AR 72034-6135 | 2007-05-02 |
| 1821172651 | Romana Rayaz | Family Medicine | 4300 W 7th St # West, Little Rock, AR 72205-5446 | 2006-10-25 |
| Find all providers with the same taxonomy | ||||
| City | LAKE VILLAGE |
| Zip Code | 71653 |
Please comment or provide details below to improve the information on SOUTHEAST REHAB LLC.
| 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.