Provider Demographics
NPI:1912971854
Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF WESTERN MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF WESTERN MASSACHUSETTS, LLC
Other - Org Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF WESTERN MASSACHUSETTS
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: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 1:222 STATE ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3437
Practice Address - Country:US
Practice Address - Phone:413-308-3300
Practice Address - Fax:413-308-3600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-15
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1102575Medicaid
15839OtherHEALTH NEW ENGLAND
2222303001OtherBLUE CROSS
904928OtherCONNECTICARE
102488500OtherDEPT OF LABOR
1903322005OtherCIGNA
903156OtherHARVARD PILGRIM
000000022519OtherBMC HEALTHNET
000000022521OtherBMC HEALTHNET
000000022522OtherBMC HEALTHNET
000000022520OtherBMC HEALTHNET
2222303010OtherBLUE CROSS
981499OtherNETWORK HEALTH
000000022518OtherBMC HEALTHNET
0013172OtherNEIGHBORHOOD HEALTH
904756OtherTUFTS
4329714OtherAETNA
904755OtherTUFTS
4329714OtherAETNA