1093840076 NPI number — ENCORE REHABILITATION, INC

Table of content: (NPI 1093840076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093840076 NPI number — ENCORE REHABILITATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENCORE REHABILITATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ENCORE REHAB OF HOOVER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093840076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 JOHNSTON ST SE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35601-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-340-9708
Provider Business Mailing Address Fax Number:
256-340-9624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 JOHN HAWKINS PKWY
Provider Second Line Business Practice Location Address:
SUITE 141K
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-682-7650
Provider Business Practice Location Address Fax Number:
205-682-9040
Provider Enumeration Date:
02/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-350-1764

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 529-917620 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003819608 . This is a "GROUP NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".