Provider Demographics
NPI:1487628616
Name:ENCOMPASS HEALTH DEACONESS REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:ENCOMPASS HEALTH DEACONESS REHABILITATION HOSPITAL, LLC
Other - Org Name:ENCOMPASS HEALTH DEACONESS REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
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 1:9001 LIBERTY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-967-7116
Mailing Address - Fax:205-969-6650
Practice Address - Street 1:9355 WARRICK TRL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-0015
Practice Address - Country:US
Practice Address - Phone:812-476-9983
Practice Address - Fax:812-476-4270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-14
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4618283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457418,OtherUMWA
000000055049OtherBLUE CROSS
285504OtherHEALTHLINK
174084500OtherDEPT OF LABOR
39839200OtherFED BLACK LUNG
IL621343808001Medicaid
30087OtherTRICARE
IN100270740AMedicaid
IN100270740AMedicaid