Provider Demographics
NPI:1538132253
Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF NORTHERN KENTUCKY, LLC
Entity Type:Organization
Organization Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF NORTHERN KENTUCKY, LLC
Other - Org Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF NORTHERN KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-970-5702
Mailing Address - Street 1:9001 LIBERTY PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7509
Mailing Address - Country:US
Mailing Address - Phone:205-967-7116
Mailing Address - Fax:205-969-6650
Practice Address - Street 1:201 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3407
Practice Address - Country:US
Practice Address - Phone:859-341-2044
Practice Address - Fax:859-341-2813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100592283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
1004025OtherAETNA
183027OtherSTERLING OPT
KY01022540Medicaid
1106670-KYOtherPASSPORT
000000055039OtherBLUE CROSS
5000174OtherUNITED HEALTHCARE
0537579OtherCIGNA
167996600OtherDEPT OF LABOR
922OtherFIRST STEPS
1539806OtherUMWA
1106670-KYOtherPASSPORT