Provider Demographics
NPI:1376294207
Name:COLUMBUS HOSPITAL LTACH LLC
Entity Type:Organization
Organization Name:COLUMBUS HOSPITAL LTACH LLC
Other - Org Name:SILVER LAKE HOSPITAL LTACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LA FORGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-387-7901
Mailing Address - Street 1:495 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1317
Mailing Address - Country:US
Mailing Address - Phone:973-387-7901
Mailing Address - Fax:973-587-7830
Practice Address - Street 1:495 N 13TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1317
Practice Address - Country:US
Practice Address - Phone:973-387-7901
Practice Address - Fax:973-587-7830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit