1669446324 NPI number — MMC ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669446324 NPI number — MMC ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MMC ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC
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:
ENCOMPASS HEALTH REHAB HOSPITAL OF TINTON FALLS
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:
1669446324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9001 LIBERTY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-7509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-967-7116
Provider Business Mailing Address Fax Number:
205-969-6650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CENTRE PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-9744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-460-5320
Provider Business Practice Location Address Fax Number:
732-460-7446
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WISNER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
205-970-5702

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  22922 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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