Provider Demographics
NPI:1508203878
Name:COLUMBUS HOSPITAL LTACH LLC
Entity Type:Organization
Organization Name:COLUMBUS HOSPITAL LTACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGUILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-587-7707
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:973-497-7770
Mailing Address - Fax:973-497-7785
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:973-587-7777
Practice Address - Fax:973-587-7830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS HOSPITAL LTACH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-28
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24009282E00000X
NJ1396282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ310242Medicare PIN