Provider Demographics
NPI:1982321485
Name:ST. JOHN ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:ST. JOHN ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC
Other - Org Name:ASCENSION ST. JOHN REHABILITATION HOSPITAL OF OWASSO, AN AFFILIATE OF
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 1:13402 E 86TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8767
Mailing Address - Country:US
Mailing Address - Phone:918-401-3100
Mailing Address - Fax:918-401-3495
Practice Address - Street 1:13402 E 86TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8767
Practice Address - Country:US
Practice Address - Phone:918-401-3100
Practice Address - Fax:918-401-3495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-25
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital