Healthcare Provider Details

I. General information

NPI: 1669400305
Provider Name (Legal Business Name): LTAC HOSPITAL DETROIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
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

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

V. Phone/Fax

Practice location:
  • Phone: 313-870-9870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberB30526
License Number StateMI

VIII. Authorized Official

Name: ALAN FISHER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 313-870-9870