Provider Demographics
NPI:1215901970
Name:VAN MATRE ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC
Entity type:Organization
Organization Name:VAN MATRE ENCOMPASS HEALTH REHABILITATION HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF THE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-970-3442
Mailing Address - Street 1:950 S MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-4274
Mailing Address - Country:US
Mailing Address - Phone:815-381-8500
Mailing Address - Fax:815-484-9035
Practice Address - Street 1:950 S MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4274
Practice Address - Country:US
Practice Address - Phone:815-381-8500
Practice Address - Fax:815-484-9035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-16
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005215283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
088249OtherHEALTH ALLIANCE
IL36439713401Medicaid
50055OtherBLUE CROSS
50055OtherBLUE CROSS
IL=========001Medicaid