Healthcare Provider Details

I. General information

NPI: 1831583145
Provider Name (Legal Business Name): MADISON REHABILITATION HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 N BILTMORE LN
MADISON WI
53718
US

IV. Provider business mailing address

5115 N BILTMORE LN
MADISON WI
53718-2161
US

V. Phone/Fax

Practice location:
  • Phone: 608-592-8101
  • Fax:
Mailing address:
  • Phone: 608-592-8100
  • Fax: 608-592-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: KENNETH M BOWMAN
Title or Position: CEO
Credential:
Phone: 608-592-8101