Provider Demographics
NPI:1043284706
Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF TUSTIN, L.P.
Entity Type:Organization
Organization Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF TUSTIN, L.P.
Other - Org Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF TUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-970-5702
Mailing Address - Street 1:15120 KENSINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1801
Mailing Address - Country:US
Mailing Address - Phone:714-832-9200
Mailing Address - Fax:714-508-4550
Practice Address - Street 1:15120 KENSINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1801
Practice Address - Country:US
Practice Address - Phone:714-832-9200
Practice Address - Fax:714-508-4550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-16
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000303283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC330304GMedicaid
3329OtherBLUE CROSS
3329OtherBLUE CROSS