Provider Demographics
NPI:1528259819
Name:LTAC HOSPITAL DETROIT
Entity type:Organization
Organization Name:LTAC HOSPITAL DETROIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHERF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-761-1500
Mailing Address - Street 1:PO BOX 48516
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-6116
Mailing Address - Country:US
Mailing Address - Phone:248-761-1500
Mailing Address - Fax:
Practice Address - Street 1:801 VIRGINIA PARK ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1925
Practice Address - Country:US
Practice Address - Phone:248-761-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
230299Medicare PIN