Organization
LTAC HOSPITAL DETROIT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN FISHER (CEO/PRESIDENT)
(313) 870-9870
Entity
Organization
Contact information
Practice address
801 VIRGINIA PARK ST, THIRD FLOOR, DETROIT, MI 48202-1925
(313) 870-9870
Mailing address
801 VIRGINIA PARK ST, THIRD FLOOR, DETROIT, MI 48202-1925
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
B30526
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
830526
ST. LIC. NO.
MI
Enumeration date
06/29/2006
Last updated
08/22/2020
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