Healthcare Provider Details

I. General information

NPI: 1528259819
Provider Name (Legal Business Name): LTAC HOSPITAL DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VIRGINIA PARK ST THIRD FLOOR
DETROIT MI
48202-1925
US

IV. Provider business mailing address

PO BOX 48516
OAK PARK MI
48237-6116
US

V. Phone/Fax

Practice location:
  • Phone: 248-761-1500
  • Fax:
Mailing address:
  • Phone: 248-761-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateMI

VIII. Authorized Official

Name: JUDITH M SCHERF
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 248-761-1500