Healthcare Provider Details

I. General information

NPI: 1417120197
Provider Name (Legal Business Name): REHABILITATION HOSPITAL OF WISCONSIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 COLDWATER CREEK DRIVE
WAUKESHA WI
53188-5031
US

IV. Provider business mailing address

1625 COLDWATER CREEK DRIVE
WAUKESHA WI
53188-5031
US

V. Phone/Fax

Practice location:
  • Phone: 314-881-4275
  • Fax: 636-730-3127
Mailing address:
  • Phone: 262-744-0659
  • Fax: 636-730-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENJAMIN MALLON
Title or Position: HOSPITAL CEO
Credential:
Phone: 262-521-8801