Provider Demographics
NPI:1508839200
Name:REHABILITATION HOSPITAL CORPORATION OF AMERICA LLC
Entity Type:Organization
Organization Name:REHABILITATION HOSPITAL CORPORATION OF AMERICA LLC
Other - Org Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF PRINCETON
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 1:120 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2352
Practice Address - Country:US
Practice Address - Phone:304-487-8000
Practice Address - Fax:304-425-7435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-12
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
228553OtherMAMSI-
231429OtherMAMSI
039038800OtherFED BLACK LUNG
228378OtherMAMSI
250024OtherCARELINK
WV0002054000Medicaid
000327164OtherBLUE CROSS
2122081OtherMAMSI
302535OtherUNITED HEALTHCARE
2122081OtherMAMSI
000327164OtherBLUE CROSS
=========-999OtherMEDICAL MUTUAL OF OHIO
=========OtherTRICARE
=========001OtherBLUE CROSS
228553OtherMAMSI-