Basic Information
| Provider Information | |||||||||
| NPI: | 1396478202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION HOSPITAL OF WESTERN WISCONSIN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W CLAIREMONT AVE FL 8 | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547016122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059677116 | ||||||||
| FaxNumber: | 2059696650 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W CLAIREMONT AVE FL 8 | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547016122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059677116 | ||||||||
| FaxNumber: | 2059696650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2022 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | WISNER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2059705702 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ENCOMPASS HEALTH CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | Y | Hospitals | Rehabilitation Hospital |
No ID Information.