Provider Demographics
NPI:1417045642
Name:MADONNA REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:MADONNA REHABILITATION HOSPITAL
Other - Org Name:REHABILITATION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONGILLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:402-413-3000
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-413-3000
Mailing Address - Fax:402-413-4113
Practice Address - Street 1:5401 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2150
Practice Address - Country:US
Practice Address - Phone:402-413-3000
Practice Address - Fax:402-413-4113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADONNA REHABILITATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500885900OtherMEDICAID
D0287OtherRAILROAD MEDICARE
IA0982017OtherMEDICAID
KS100187780DOtherMEDICAID
NE7729OtherBLUE CROSS
KS100187780DOtherMEDICAID
=========OtherTRICARE
NE=========25OtherMEDICAID
KS100187780DOtherMEDICAID