Provider Demographics
NPI:1932335239
Name:LTAC INVESTORS LLC
Entity Type:Organization
Organization Name:LTAC INVESTORS LLC
Other - Org Name:LIFE LINE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-346-2600
Mailing Address - Street 1:200 SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-9620
Mailing Address - Country:US
Mailing Address - Phone:740-346-2600
Mailing Address - Fax:740-346-2602
Practice Address - Street 1:200 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-9620
Practice Address - Country:US
Practice Address - Phone:740-346-2600
Practice Address - Fax:740-346-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1493282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3036753Medicaid
OH3130785Medicaid
WV3810018429Medicaid
OH362039Medicare Oscar/Certification
OH3130785Medicaid