Provider Demographics
NPI:1194799023
Name:NEW ENGLAND REHABILITATION HOSPITAL OF PORTLAND, LLC
Entity type:Organization
Organization Name:NEW ENGLAND REHABILITATION HOSPITAL OF PORTLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:205-970-5669
Mailing Address - Street 1:9001 LIBERTY PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7509
Mailing Address - Country:US
Mailing Address - Phone:205-970-5735
Mailing Address - Fax:205-969-6650
Practice Address - Street 1:335 BRIGHTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2374
Practice Address - Country:US
Practice Address - Phone:207-775-4000
Practice Address - Fax:207-662-8446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-15
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34370283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
M15100OtherCIGNA
928495OtherAETNA
ME187640000Medicaid
24787OtherBLUE CROSS
ME187640000Medicaid