Provider Demographics
NPI:1508920356
Name:SACRED HEART REHABILITATION INSTITUTE, INC.
Entity Type:Organization
Organization Name:SACRED HEART REHABILITATION INSTITUTE, INC.
Other - Org Name:ASCENSION SACRED HEART REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3000
Mailing Address - Street 1:PO BOX 773446
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3446
Mailing Address - Country:US
Mailing Address - Phone:414-585-6884
Mailing Address - Fax:
Practice Address - Street 1:13111 N PORT WASHINGTON RD FL 2
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2416
Practice Address - Country:US
Practice Address - Phone:414-585-6884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11020000Medicaid
WI41223600Medicaid
WI11020000Medicaid
WI11020081Medicaid
WI11020000Medicaid