Provider Demographics
NPI:1609287937
Name:QUILLEN REHABILITATION HOSPITAL OF JOHNSON CITY LLC
Entity Type:Organization
Organization Name:QUILLEN REHABILITATION HOSPITAL OF JOHNSON CITY LLC
Other - Org Name:QUILLEN REHAB HOSP, A JV OF BALLAD HEALTH AND ENCOMPASS HEALTH
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:205-967-7116
Mailing Address - Street 1:9001 LIBERTY PARKWAY
Mailing Address - Street 2:ATTN: ROBERT WISNER, SVP- REIMBURSEMENT
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 1:2511 WESLEY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1723
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-08
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
443033Medicare Oscar/Certification