NPIMap

Organization Active NPI

Southeast Rehab LLC

Doing business as Southeast Rehabilitation Hospital

  • Rehabilitation Hospital
  • Lake Village, AR
National Provider Identifier
1700959905
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
License
AR4376 Issued in AR
Legal business name
SOUTHEAST REHAB LLC
Doing business as
Southeast Rehabilitation Hospital
Practice address
905 Borgognoni Dr
Lake Village, AR 71653-1623
Phone
(318) 665-9950
Fax
(318) 665-0379
NPI assigned
Nov 16, 2006
Last updated
Nov 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Catherine Martin Waldrop, MED, LPC, NBCC
Title
Administrator/Ceo
Phone
(318) 665-9950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X AR4376 AR Primary

Addresses

Primary practice location

905 Borgognoni Dr
Lake Village, AR 71653-1623

Mailing address

905 Borgognoni Dr
Lake Village, AR 71653-1623
Phone (318) 665-9950

Other identifiers 1

IdentifierTypeStateIssuer
163180526MedicaidAR

Other names 1

  • Southeast Rehabilitation Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061130000333 AR Part A Provider - Hospital 6709884604 Practice locations: Lake Village, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700959905. Details of each certification follow.

Hospital certification: CCN 043034

Legal name
SOUTHEAST REHAB LLC.
Doing business as
SOUTHEAST REHABILITATION HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Dec 13, 2006
Last certification
May 31, 2018
Beds
10
Ownership / control type
Physician ownership
Organization structure
LLCProprietary
Incorporated
Oct 21, 2005 in AR
Enrollment address
905 Borgognoni Dr
Lake Village, AR 71653
Other Hospital Practice Location
Hospital subgroups
Rehabilitation unit, Other

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Southeast Rehabilitation HospitalCCN 043034 · All quality measures
Ownership
Physician
Certified
Dec 13, 2006
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D1059020Southeast Rehabilitation Hospital905 Borgognoni Dr, Lake Village, AR 71653Certificate of waiverSep 19, 2026

National Provider Directory

National Provider Directory

Locations

2729A S Highway 65 82
Lake Village, AR 71653
Phone (870) 265-4333

608 S Highway 65 82
Ste A
Lake Village, AR 71653

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John M Lipka Individual 5% Or Greater Direct Ownership Interest Nov 1, 2006
Diane Carothers Individual 5% Or Greater Direct Ownership Interest Aug 13, 2009
James C Wright Individual 5% Or Greater Direct Ownership Interest Nov 1, 2006
Allen L Spires Individual 5% Or Greater Direct Ownership Interest Nov 1, 2006
Southeast Rehab LLC. Organization, Lake Village, AR LLC, For-profit Operational/Managerial Control Nov 1, 2006 100%
John R Russell Individual 5% Or Greater Direct Ownership Interest Nov 1, 2006
Catherine M Waldrop Individual 5% Or Greater Direct Ownership InterestAdministrator Nov 1, 2017 7.8%
Operational/Managerial ControlInterim Ceo Nov 1, 2017 100%
John P Burge Individual 5% Or Greater Direct Ownership Interest Nov 1, 2006
Monie Melinda Wright Individual 5% Or Greater Direct Ownership Interest Nov 17, 2010 6.06%
Stacy Noble Individual 5% Or Greater Direct Ownership InterestBoard Member Nov 1, 2009 7.8%
Robert L Miller Individual 5% Or Greater Direct Ownership Interest Feb 9, 2023 9.28%

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762473600000",
    "number": "1700959905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 BORGOGNONI DR",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531623",
            "telephone_number": "318-665-9950",
            "fax_number": "318-665-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 BORGOGNONI DR",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531623",
            "telephone_number": "318-665-9950",
            "fax_number": "318-665-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A",
        "authorized_official_last_name": "WALDROP",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "318-665-9950",
        "authorized_official_credential": "MED, LPC, NBCC"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "AR",
            "license": "AR4376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163180526",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Village, AR

Sources for this page

Verify at the official NPI Registry.