Basic Information
Provider Information
NPI: 1225001928
EntityType: 2
ReplacementNPI:  
OrganizationName: ENCOMPASS HEALTH REHABILITATION HOSPITAL OF ALBUQUERQUE, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ENCOMPASS HEALTH REHABILITATION HOSPITAL OF ALBUQUERQUE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9001 LIBERTY PKWY
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352427509
CountryCode: US
TelephoneNumber: 2059677116
FaxNumber: 2059696650
Practice Location
Address1: 7000 JEFFERSON ST NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871094313
CountryCode: US
TelephoneNumber: 5053449478
FaxNumber: 5053412717
Other Information
ProviderEnumerationDate: 02/12/2006
LastUpdateDate: 10/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WISNER
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: M.
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 2059677116
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: ENCOMPASS HEALTH CORPORATION
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
283X00000X  Y HospitalsRehabilitation Hospital 

No ID Information.


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