Provider Demographics
NPI:1669446324
Name:MMC ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:MMC ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC
Other - Org Name:ENCOMPASS HEALTH REHAB HOSPITAL OF TINTON FALLS
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:MARTIN
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 1:2 CENTRE PLAZA
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-9744
Practice Address - Country:US
Practice Address - Phone:732-460-5320
Practice Address - Fax:732-460-7446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-16
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22922283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
190524OtherAMERIGROUP
313035OtherBLUE CROSS
1034309OtherMERCY
NJ8908109Medicaid
2027070OtherFIRST HEALTH
IL4460OtherHEALTHNET
351890100OtherACS
2723537OtherAETNA
2027070OtherFIRST HEALTH