Healthcare Provider Details

I. General information

NPI: 1508203878
Provider Name (Legal Business Name): COLUMBUS HOSPITAL LTACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 N 13TH ST
NEWARK NJ
07107-1317
US

IV. Provider business mailing address

495 N 13TH ST
NEWARK NJ
07107-1317
US

V. Phone/Fax

Practice location:
  • Phone: 973-587-7777
  • Fax: 973-587-7830
Mailing address:
  • Phone: 973-497-7770
  • Fax: 973-497-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number24009
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1396
License Number StateNJ

VIII. Authorized Official

Name: RICHARD BURGUILLOS
Title or Position: CFO
Credential:
Phone: 973-587-7707